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  • 1.Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Chapter 16Care of Preoperative Patients

2. 2Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Period Begins when patient is scheduled for surgery;ends at time of transfer to surgical suite Nurse functions as educator, advocate,promoter of health and safety 3. 3Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient & Family Teaching Tubes Drains Vascular access 4. 4Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Nasogastric Tube 5. 5Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Prevention of RespiratoryComplications Breathing exercises Incentive spirometry Coughing and splinting 6. 6Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Changes of Agingas Surgical Risk Factors Decreased: Cardiac output, peripheral circulation Vital capacity, blood oxygenation Blood flow to kidneys, glomerular filtration rate Increased: Blood pressure Risk for skin damage, infection Sensory deficits Deformities related to osteoporosis/arthritis 7. 7Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Considerations forPreoperative Care Chronic illness Malnutrition Impaired self-care ability Allergies Inadequate support systems 8. 8Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Older Adults: Considerations forPreoperative Care (contd) Stress from surgery/anesthesia Cardiopulmonary complications after surgery Mental status changes Risk for falls 9. 9Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Reasons for Surgery Diagnostic determines origin and cause ofdisorder Curative resolves health problem byrepairing or removing cause Restorative improves patients functionalability Palliative relieves symptoms of diseaseprocess, but does not cure Cosmetic alters/enhances personalappearance 10. 10Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Urgency and Degree of Risk ofSurgery Urgency: Elective Urgent Emergent Degree of Risk: Minor Major 11. 11Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Extent of Surgery Simple Radical Minimally invasive (MIS) 12. 12Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Anxiety Interventions Preoperative teaching Encourage communication Promote rest Use distraction Teach family members 13. 13Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Skin Preparation Break in the skin increases risk for infection Patient may be asked to shower usingantiseptic solution Hair removal by electric clippers, depilatories Shaving of hair creates risk for infection! 14. 14Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Drugs Reduce anxiety Promote relaxation Reduce nasal and oral secretions 15. 15Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Drugs (contd) Prevent laryngospasm Reduce vagal-induced bradycardia Inhibit gastric secretion Decrease amount of anesthetic needed forinduction and maintenance of anesthesia 16. 16Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Collaborative Management:Assessment History and data collection: Age Drugs, substance use Medical history (including cardiac and pulmonary) Complementary/alternative practices Previous surgical procedures, anesthesia Blood donations Discharge planning 17. 17Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Physical Assessment/ClinicalManifestations Obtain baseline vital signs Focus on problem areas identified in history;all body systems affected by surgicalprocedure Report abnormal assessment findings tosurgeon/anesthesiology personnel 18. 18Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.System Assessment Cardiovascular CAD, MI within 6 months beforesurgery, angina, hypertension, dysrhythmias Respiratory Chronic respiratory problems Smoking increases carboxyhemoglobin bloodlevel, deceases oxygen delivery Renal/Urinary Kidney impairment inhibits drugs/anesthetic agentexcretion 19. 19Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.System Assessment (contd) Neurologic Determine baseline Assess LOC, ability to follow commands Musculoskeletal Nutritional status Malnutrition and obesity increase surgical risk Psychosocial 20. 20Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Prevention of CardiovascularComplications Be aware of patients at greater risk for DVT Antiembolism stockings Pneumatic compression devices Leg exercises Mobility 21. 21Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Laboratory Assessment Urinalysis Blood type and crossmatch CBC or hemoglobin level and hematocrit Clotting studies (PT, INR, aPTT) 22. 22Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Laboratory Assessment (contd) Electrolyte levels Serum creatinine level Pregnancy test Chest x-ray ECG 23. 23Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Insufficient Information Interventions Preoperative teaching Informed consent: Surgeon obtains signed consent before sedationand/or surgery Nurse clarifies facts and dispels myths aboutsurgery Nurse not responsible for providing detailedinformation about procedure! 24. 24Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Informed Consent Patients may sign with X In emergency, telephone authorization isacceptable Special permits required for some procedures 25. 25Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.NPSGs and Informed Consent Ensure correct site is selected and wrong siteis avoided Licensed independent practitioner markssite, involving patient if possible Time out procedure adopted by mostfacilities 26. 26Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Implementing Dietary Restrictions NPO: Patient not to ingest anything by mouthfor 6 to 8 hours before surgery: Decreases risk for aspiration Give patients written/oral directions to stressadherence Surgery can be canceled if instructions notfollowed 27. 27Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Administering Regularly ScheduledMedications Consult with physician and anesthesiaprovider for instructions Drugs for certain conditions often allowedwith a sip of water: Cardiac disease Respiratory disease Seizures Hypertension 28. 28Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Intestinal Preparation Performed to prevent injury to colon; reducenumber of intestinal bacteria Enema or laxative 29. 29Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patient Using Incentive Spirometer 30. 30Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patients at Risk for VTE Obese patients Age 40 or older History of cancer Decreased mobility or immobile Spinal cord injury 31. 31Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Patients at Risk for VTE (contd) History of VTE, PE, varicose veins, edema Oral contraceptives Smoking History of decreased cardiac output Hip fracture, total hip/knee surgery 32. 32Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.External Pneumatic CompressionDevices 33. 33Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Chart Review Ensure all documentation, preoperativeprocedures, orders are complete Check surgical consent form and others forcompleteness Inform patient that area will be marked beforeprocedure begins Document allergies, height, and weight 34. 34Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Chart Review (contd) Ensure all laboratory and diagnostic testresults are in chart Document/report any abnormal results Report special needs and concerns 35. 35Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Patient Preparation Remove most clothing; provide gown Leave valuables with family member or lockup Tape rings in place if cannot be removed Ensure patient is wearing ID band 36. 36Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.Preoperative Patient Preparation(contd) Remove: Dentures Prosthetic devices Hearing aids Contact lenses Fingernail polish Artificial nails Pierced jewelry