Preoperative investigation and preoperative teaching

PERIOPERATIVE INVESTIGATION AND PERIOPERATIVE TEACHING

1. Preoperative investigation and preoperative teaching -RIYA SANJAY BAGHELE NAGPUR

2. Introduction :- 1} Preoperative investigation :- The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patient complicationsduring the anaesthetic , surgical, or post-operative period. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery.
In this article, we shall look at the components of an effective pre-operative history, examination and routine investigations that can be performed. 2} preoperative teaching :- In terms of the surgical patient, some of the most important education we provide is preoperative education before surgery. The goal of preoperative education is to not only prepare the patient for surgery but also to prepare them for what to expect following the surgery.

3. Pre-Operative Investigations :- 1) The nature of the exact investigations required depends on a number of factors, including co-morbidities, age, and the nature of the procedure. 2) Each specific hospital is likely to provide local guidelines, however it is useful to understand the tests than could be done pre-operatively and have an appreciation as to why each may be requested. NICE produce a colour traffic light table which can further guide your investigative decisions .

4. INVESTIGATIONS
1) FULL BLOOD COUNT (WHEN TO PERFORM )

•All emergency Pre-operative cases •All elective Pre-operative cases over 6o years

•All elective Pre-operative cases in adult femalesIf surgery likely to result in significant blood loss
Suspicion of blood loss, anemia,sepsis , CRD,coagulation problems

5. 2.) UREA & ELECTROLYTES(WHEN TO PERFORM?) •All Pre-operative cases over 65Positive result from U/A •All pt with cardiopulmonary dis. or taking diuretics, steroidsAll pt with H/O renal/liver dis.or abn . nutritional state All pt with H/O diarrhea/vomiting or other metabolic/endocrine dis. •All pt with IVF for more than 24hr's

6. PREOPERATIVE TEACHING :-
Pre operative teaching must address highest priority and include information that focus on safety of the patient. It mainly concerns three types of information. It include sensory, procedural and process information

7. Sensory informations :-
•Holding area may be noisy
•Drugs and cleaning solution can be smelled
•Operation theatre can be cold , warm blankets are available
•Talking may be distorted in OT due to mask. Questions should be asked if something is not understood.

8. •OT bed will be narrow. A safety belt will be applied over the knees
•Light in the OT may be very bright
•Monitoring machines (tickling and pinging noises)may be heard when awake. Their purpose is to monitor and ensure safety

9. Procedural information:-•What to bring and what type of clothing wear to the ambulatory surgery centre • Any changes at the time of surgery
•Fluids and food restrictions
•Physical preparation required
•Purpose of frequent vital sign assessment

10. •Pain control and other comfort measures
•Insertion of IV line
•Procedure for anaesthesia administration
•Expected surgical site and or side marked with ink or marker

11. Process information
•Admission area
•Preoperative holding area, operating room amd recovery room
•Families can usually stay in holding area until surgery
•Families may be able to enter recovery area as soon as patient is awake

12. • Identification of any technology that may present on awakeningsuch as monitors and central lines

13. ----Thank you----