Preoperative:
begins with the decision to perform surgery and continues until the
client has reached the operating area . It includes both physical and
psychological preparation.
Preoperative Assessment : I. Review preoperative laboratory and diagnostic studies II. Review the client’s health history and preparation for surgery III. Assess physical needs IV. Assess psychological needs
I. Review preoperative laboratory and diagnostic studies: • Complete blood count. • Blood type and cross match. • Serum electrolytes • Urinalysis. • Chest X-rays • Electrocardiogram. • Other tests related to procedure or client’s medical condition, such as: prothrombin time, partial thromboplastin time, blood urea nitrogen, creatinine, and other radiographic studies.
II. Review the client’s health history and preparation for surgery: • History of present illness and reason for surgery • Past medical history • Medical conditions (acute and chronic) • Previous hospitalization and surgeries • History of any past problem with anesthesia • Allergies • Present medications • Substance use: alcohol, tobacco, street drugs
III. Assess physical needs: • Ability to communicate • Vital signs • Weight and height • Skin integrity • Ability to move/ ambulate • Prostheses
IV. Assess psychological needs: • Level of understanding of surgical procedure, preoperative and postoperative instruction • Coping strategies • Support system
Surgical consent : • Before surgery, the client must sign a surgical consent form or operative permit. • Clients must sign a consent form for any procedure that requires anesthesia and has risks of complications. • If an adult client is confused, unconscious, a family member or guardian must sign the consent form. • If the client is younger than 18 years of age, a parent or legal guardian must sign the consent form. • In an emergency, the surgeon may have to operate without consent, health care personnel, however, makes every effort to obtain consent by telephone, or fax. • Each nurse must be familiar with agency policies and state laws regarding surgical consent forms. • Clients must sign the consent form before receiving any preoperative sedatives. • The nurse is responsible for ensuring that all necessary parties have signed the consent form and that it is in the client’s chart before the client goes to the operating room (OR).
Preoperative Teaching : • Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period • The nurse adapts instructions and expectations to the client’s ability to understand. • Information in a preoperative teaching plan varies with the type of surgery and the length of the hospitalization.
Preoperative Teaching Plan Includes: • Preoperative medication- when they are given and their effects.
• Post operative pain control. • Explanation and description of post surgical area.
• Discussion of the frequency of assessing vital signs and use of monitoring equipmen
• Explanation and demonstration deep breathing and , position changes,
• Information about intravenous (IV) fluids and other lines and tubes such as nasogastric tubes
• Preoperative teaching time also gives the client the chance to express any anxieties and fears and for the nurse to provide explanations that will help alleviate those fears.
• When clients are admitted for emergency surgery, time for explanation is unavailable; explanations will be more complete during the postoperative period
Surgical Risk Factors: • Age → Very young – Elderly
• Nutritional Status →Malnourished – Low weight – Obese
• Medical Problems →Acute and chronic respiratory problems – Hypertension – Liver dysfunction – Renal failure – Diabetes
Preoperative Preparation: 1. Physical Preparation. • Skin preparation • Elimination • Food and fluids • clothing/ grooming • Prostheses
2. Psychosocial Preparation. • Careful preoperative teaching can reduce fear and anxiety of the clients.
Postoperative Care: begins with admission to the recovery area and continues until the client receives a follow up evaluation at home.
1. Immediate postoperative period. Initial Assessment :
• Airway patency • Effectiveness of respiration • Mechanical ventilation, or supplemental oxygen • vital signs • Wound condition, including dressings and drains • Fluid balance, including IV fluids, output from catheters and drains and ability to void • Level of consciousness and pain
2. Later postoperative period. Ongoing Assessment:
• Respiratory function • General condition • Vital signs • Cardiovascular function • Fluid status • Pain level • Bowel and urinary elimination • Dressings, tubes, drains, and IV lines
Nurse’s Responsibilities in Postoperative Phase: • Ensures a patent airway • Helps maintain adequate circulation • Prevents or assist with the treatment of shack • Maintains proper position and function of drain tubes and IV infusion • Monitor for potential complications
Postoperative Complications: • Hemorrhage • Shock • Hypoxia • Aspiration
Preoperative Assessment : I. Review preoperative laboratory and diagnostic studies II. Review the client’s health history and preparation for surgery III. Assess physical needs IV. Assess psychological needs
I. Review preoperative laboratory and diagnostic studies: • Complete blood count. • Blood type and cross match. • Serum electrolytes • Urinalysis. • Chest X-rays • Electrocardiogram. • Other tests related to procedure or client’s medical condition, such as: prothrombin time, partial thromboplastin time, blood urea nitrogen, creatinine, and other radiographic studies.
II. Review the client’s health history and preparation for surgery: • History of present illness and reason for surgery • Past medical history • Medical conditions (acute and chronic) • Previous hospitalization and surgeries • History of any past problem with anesthesia • Allergies • Present medications • Substance use: alcohol, tobacco, street drugs
III. Assess physical needs: • Ability to communicate • Vital signs • Weight and height • Skin integrity • Ability to move/ ambulate • Prostheses
IV. Assess psychological needs: • Level of understanding of surgical procedure, preoperative and postoperative instruction • Coping strategies • Support system
Surgical consent : • Before surgery, the client must sign a surgical consent form or operative permit. • Clients must sign a consent form for any procedure that requires anesthesia and has risks of complications. • If an adult client is confused, unconscious, a family member or guardian must sign the consent form. • If the client is younger than 18 years of age, a parent or legal guardian must sign the consent form. • In an emergency, the surgeon may have to operate without consent, health care personnel, however, makes every effort to obtain consent by telephone, or fax. • Each nurse must be familiar with agency policies and state laws regarding surgical consent forms. • Clients must sign the consent form before receiving any preoperative sedatives. • The nurse is responsible for ensuring that all necessary parties have signed the consent form and that it is in the client’s chart before the client goes to the operating room (OR).
Preoperative Teaching : • Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period • The nurse adapts instructions and expectations to the client’s ability to understand. • Information in a preoperative teaching plan varies with the type of surgery and the length of the hospitalization.
Preoperative Teaching Plan Includes: • Preoperative medication- when they are given and their effects.
• Post operative pain control. • Explanation and description of post surgical area.
• Discussion of the frequency of assessing vital signs and use of monitoring equipmen
• Explanation and demonstration deep breathing and , position changes,
• Information about intravenous (IV) fluids and other lines and tubes such as nasogastric tubes
• Preoperative teaching time also gives the client the chance to express any anxieties and fears and for the nurse to provide explanations that will help alleviate those fears.
• When clients are admitted for emergency surgery, time for explanation is unavailable; explanations will be more complete during the postoperative period
Surgical Risk Factors: • Age → Very young – Elderly
• Nutritional Status →Malnourished – Low weight – Obese
• Medical Problems →Acute and chronic respiratory problems – Hypertension – Liver dysfunction – Renal failure – Diabetes
Preoperative Preparation: 1. Physical Preparation. • Skin preparation • Elimination • Food and fluids • clothing/ grooming • Prostheses
2. Psychosocial Preparation. • Careful preoperative teaching can reduce fear and anxiety of the clients.
Postoperative Care: begins with admission to the recovery area and continues until the client receives a follow up evaluation at home.
1. Immediate postoperative period. Initial Assessment :
• Airway patency • Effectiveness of respiration • Mechanical ventilation, or supplemental oxygen • vital signs • Wound condition, including dressings and drains • Fluid balance, including IV fluids, output from catheters and drains and ability to void • Level of consciousness and pain
2. Later postoperative period. Ongoing Assessment:
• Respiratory function • General condition • Vital signs • Cardiovascular function • Fluid status • Pain level • Bowel and urinary elimination • Dressings, tubes, drains, and IV lines
Nurse’s Responsibilities in Postoperative Phase: • Ensures a patent airway • Helps maintain adequate circulation • Prevents or assist with the treatment of shack • Maintains proper position and function of drain tubes and IV infusion • Monitor for potential complications
Postoperative Complications: • Hemorrhage • Shock • Hypoxia • Aspiration
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