PRE-OPERATIVE NURSING CARE Sido & Char.pptx

Presentation on preoperative nursing care to help nurses manage patients before any surgery.

1. PRE-OPERATIVE NURSING CARE CONTENTS DEFINITION OF TERMS. AIMS OF PRE-OPERATIVE NURSING CARE. ROLE OF THE NURSE IN THE PRE-OPERATIVE PHASE / PERIOD. 3 .1. Pre-operative Assessment. 3 .2. Obtaining Informed Consent. 3 .3. Pre-operative Teaching. 3 .4. Physical Preparation Of Patient. 3 .5. Psychological Preparation Of Patient.

2. DEFINITIONS OF TERMS Pre-operative phase/ period : begins with the decision to perform surgery and continues until the client has reached the operating area ( operating room) or surgery begins. Pre-operative nursing care : is care given before surgery when physical and psychological preparations are made for the operation, according to the individual needs of the patient.

3. 2 . AIMS OF PRE-OPERATIVE NURSING CARE. The aims of pre-operative nursing care are : T o reduce the risks associated with surgery and anesthesia. To obtain the patient’s informed consent for both surgery and anesthesia. To restore the patient to the desired level of function. To increase the quality of intra-operative care.

4. 3. ROLE OF THE NURSE IN THE PRE-OPERATIVE PHASE / PERIOD. 3.1. Pre-operative Assessment Here, co-morbidities that may lead to patient complications during the anesthetic, intra-operative or post-operative period are identified. And if any, it needs to be treated before the surgery. This is done as follows: Review of preoperative laboratory and diagnostic studies: •Full blood count. •Blood group / rhesus 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.

5. II. Review the client’s health history: • 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. •Social history ( substance use): alcohol, tobacco, drugs. •Review of system.

6. III. Assess physical needs: •Ability to communicate. •Vital signs ( blood pressure, pulse , temperature, oxygen saturation) •Level of consciousness (Confusion, Drowsiness or Unresponsiveness ). •nutritional status (weight , height and BMI) •Ability to move/ ambulate. •Circulatory status ( auscultation, vein observation)

7. IV. Assess psychological needs: •Emotional state. •Level of understanding of surgical procedure, preoperative and postoperative instruction. •Coping strategies. •Support system. V. Assess cultural needs: •Language-need for interpreter

8. 3.2 OBTAINING INFORMED 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. 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). N.B: Each nurse must be familiar with hospital policies and state laws regarding surgical consent forms.

9. 3.3. Pre-operative Teaching. Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period. Clients are more alert and free of pain at this time. It also reduces apprehension and fear thus increasing cooperation and participation in the post-operative phase, and decreases the incidence and severity of post-operative complications. Information in a preoperative teaching plan varies with the type of surgery and the length of the hospitalization.

10. PRE-OPERATIVE TEACHING PLAN INCLUDES Pre-operative medication: In general , patients taking cardiac drugs, including β-blockers and antiarrhythmics , pulmonary drugs such as inhaled or nebulized medications , or anticonvulsants , antihypertensives , or psychiatric drugs are advised to take their medications with a sip of water on the morning of surgery day when the patient is Nil By Mouth. Some drugs are associated with an increased risk for perioperative bleeding(e.g. anticoagulants ) and are withheld before surgery . Drugs that affect platelet function are withheld for variable periods: aspirin and clopidogrel are withheld for 7 to 10 days. In High risk cases, Clopidogrel is stopped and Aspirin is continued. The use of estrogen and tamoxifen has been associated with an increased risk for thromboembolism, they probably need to be withheld for a period of 4 weeks preoperatively .

11. Pre-operative medication cont’d Non–insulin-dependent diabetics need to discontinue long-acting sulfonylureas such as chlorpropamide and glyburide because of the risk for intra-operative hypoglycemia; a shorter-acting agent or sliding-scale insulin coverage may be substituted in this period. Patients who are on Rapid-acting ( Lispro ) and short-acting (Regular) insulin preparations, these are usually withheld when the patient stops oral intake (NBM/NPO). Withhold long-acting insulin preparations; lower dosages of intermediate-acting insulin are substituted on the morning of surgery. Patients who take oral hypoglycemic agents typically withhold their normal dose the day of surgery. The use of metformin is stopped pre-operatively because of its association with lactic-acidosis in the setting of renal insufficiency( * If the patient has altered renal function, metformin needs to be discontinued until renal function either normalizes or stabilizes). Coverage for hyperglycemia is with a short-acting insulin preparation based on blood glucose monitoring. N.B: * Patients can resume their oral agent once diet is resumed. The use of estrogen and tamoxifen has been associated with an increased risk for thrombo -embolism, they probably need to be withheld for a period of 4 weeks preoperatively. Surgery is postponed for 6 weeks if Hormone Replacement Therapy(HRT) is being given.

12. PRE-OPERATIVE TEACHING PLAN INCLUDES cont’d Post operative pain control. Discussion of the frequency of checking dressings and assessing vital signs and use of monitoring equipment. Orientation of patient to the surroundings. Deep breathing and coughing exercises. How to support the incision for breathing exercises and moving . E arly ambulation in order to stimulate gastrointestinal motility, enhance lungs expansion, mobilize secretions, promote venous return and prevent rigidity of joints. Position changes. Feet and leg exercises . Informing the family of surgery time, if known, and of any schedule changes. Postoperative IV lines and tubings ex: NG tube etc.

13. 3.4. Physical Preparation Of Patient. Preoperative preparation includes the following areas: Nutrition and fluids Elimination Hygiene Medications Sleep Care of valuables Prostheses Special orders Surgical skin preparation Safety protocols Vital signs Anti embolic stockings

14. Nutrition and fluids Adequate hydration and nutrition promote healing. Usually “NPO after midnight” followed because it anesthetics depress gastrointestinal functioning and there was a danger the client would vomit and aspirate during the administration of a general anesthetic. The current guidelines allow for : The consumption of clear liquids up to 2 hours. The consumption of breast milk 4 hours before surgery. A light breakfast (e.g., formula, milk, light meal such as tea and toast) 6 hours before the procedure . A heavier meal 8 hours before surgery.

15. ll. Bowel and bladder Elimination: Enemas may be ordered if bowel surgery is planned. The enemas help prevent contamination of the surgical area (during surgery) by feces. Prior to surgery an indwelling Foley catheter may be ordered to ensure that the bladder remains empty. This helps prevent injury to the bladder, particularly during pelvic surgery.

16. lll . Hygiene: In some settings, clients are asked to bathe or shower the evening or morning of surgery (or both). The purpose of hygienic measures is to reduce the risk of wound infection by reducing the amount of bacteria on the client’s skin. The client’s nails should be trimmed and free of polish, and all cosmetics should be removed so that the nail beds, skin, and lips are visible when circulation is assessed during the perioperative phases.

17. IV. Pre operative Medications: preoperative medications are given to the client prior to going to the operating room. Commonly used preoperative medications includes: Antiemetics Anticholinergics Sedatives Antibiotics

18. V. Sleep: Nurses should do everything to help the client sleep the night before surgery. Often a sedative is ordered. EG: ALPRAZOLAM (0.5mg) or TRANXENE(10mg) Adequate sleep helps the client manage the stress of surgery and helps healing. VI. Care of valuables: Valuables such as jewelry and money should be sent home with the client’s family or significant other. If valuables/money cannot be sent home, they need to be labeled and placed in a locked storage area per the agency’s policy.

19. VII. Care of Prostheses: All prostheses (artificial body parts) such as partial or complete dentures, contact lenses, artificial eyes, and artificial limbs and eyeglasses, wigs, and false eyelashes must be removed before surgery. VIII. Special Orders: The nurse checks the surgeon’s orders for special requirements (e.g., the insertion of a naso-gastric tube prior to surgery, the administration of medications, such as insulin, or the application of anti-emboli stockings).

20. Skin Preparation. The surgical site is cleansed with an antimicrobial to remove soil and reduce the resident microbial count to sub pathogenic levels. REMOVE THE HAIR at the site of surgery . Safety Protocols: INCLUDES: Identifying the patient and surgery to be performed. Surgical site marking.

21. Vital Signs: In the preoperative phase the nurse assesses and documents vital signs for baseline data. The nurse reports any abnormal findings, such as elevated blood pressure or elevated temperature. Antiembolic Stockings : Antiembolic (elastic) stockings are firm elastic hose that compress the veins of the legs and thereby facilitate the return of venous blood to the heart. Especially in patients with deep venous thrombosis, to reduce oedema and pain.

22. 3.5. Psychological Preparation Of Patient . Careful preoperative teaching can reduce fear and anxiety of the clients. N.B : IV access is placed by the nurse or anesthesia personnel for all clients undergoing surgery. T he IV line is usually placed in the arm or the posterior aspect of the hand using a large ( 16 or 18- G) catheter. This type of catheter provides the least resistance to fluid or blood infusion, especially in an emergency when rapid infusions may be necessary. Depending on the individual client’s needs and the facility’s policies and practices, the IV access can be placed before surgery when the client is in the hospital room, in the admission area of the OR, or in the OR. The nurse reviews the client’s chart to ensure that all documentation, pre-op procedures, and orders are completed. The nurse also confirms that the scheduled procedure, including the identification of left versus right when necessary , is what is listed on the consent form. Any abnormal results( lab/ VS) are documented and reported to the surgeon or anesthetist.