Interventions for Interventions for

Preoperative Clients Preoperative Clients CareCare

Perioperative CarePerioperative Care

Three PhasesThree Phases Preoperative Preoperative

IntraoperativeIntraoperative

PostoperativePostoperative

Surgical ClassificationsSurgical Classifications1. Optional surgery1. Optional surgery: decision rests with patient (eg, cosmetic surgery).: decision rests with patient (eg, cosmetic surgery).2. Elective surgery2. Elective surgery refers to procedures that scheduled at the client's refers to procedures that scheduled at the client's convenience (eg, cyst removal, repair of scars simple hernia or convenience (eg, cyst removal, repair of scars simple hernia or vaginal repair).vaginal repair).3. Required surgery3. Required surgery: is warranted for conditions necessitating: is warranted for conditions necessitating intervention within a few weeks (eg, cataract surgery, thyroid intervention within a few weeks (eg, cataract surgery, thyroid

disorders).disorders).4. Urgent surgery:4. Urgent surgery: is indicated for a problem requiring intervention is indicated for a problem requiring intervention within 24 to 48 hours (eg, some cancers, acute gallbladder infectionwithin 24 to 48 hours (eg, some cancers, acute gallbladder infection and appendicitis, Kidney stones).and appendicitis, Kidney stones).5. Emergency surgery: 5. Emergency surgery: describes procedures that must be donedescribes procedures that must be done immediately to sustain life or maintain function (eg, repair of aimmediately to sustain life or maintain function (eg, repair of a ruptured aortic aneurysm, gunshot, or knife wounds, extensive burnsruptured aortic aneurysm, gunshot, or knife wounds, extensive burns , fractures skull, intestinal obstruction), fractures skull, intestinal obstruction)

Informed ConsentInformed Consent Information on the surgical procedure is provided by Information on the surgical procedure is provided by

the physicianthe physician Explanation includes permission a client gives after Explanation includes permission a client gives after

an explanation of the risks, benefits, and alternativesan explanation of the risks, benefits, and alternatives A signed form, witnessed by a nurse is evidence that A signed form, witnessed by a nurse is evidence that

consent has been obtainedconsent has been obtained If the client is mentally confused, unconscious, or If the client is mentally confused, unconscious, or

mentally incompetent, the client’s spouse, nearest mentally incompetent, the client’s spouse, nearest blood relative, or someone with durable power of blood relative, or someone with durable power of attorney for the client’s health care must sign the attorney for the client’s health care must sign the consent form.consent form.

PREOPERATIVE NURSING CAREPREOPERATIVE NURSING CARE

CONDUCT A NURSING ASSESSMENTCONDUCT A NURSING ASSESSMENT PROVIDE PREOPERATIVE TEACHINGPROVIDE PREOPERATIVE TEACHING PERFORM METHODS OF PHYSICALPERFORM METHODS OF PHYSICAL PREPARATIONPREPARATION ADMINISTER MEDICATIONSADMINISTER MEDICATIONS ASSIST WITH PSYCHOSOCIAL ASSIST WITH PSYCHOSOCIAL

PREPARATIONPREPARATION COMPLETE THE SURGICAL CHECKLISTCOMPLETE THE SURGICAL CHECKLIST

SURGERY CHECKLISTSURGERY CHECKLIST

Purposes of SurgeryPurposes of Surgery

DiagnosticDiagnostic CurativeCurative RestorativeRestorative Palliative surgery, which makes Palliative surgery, which makes

the client more comfortablethe client more comfortable Cosmetic surgery, which Cosmetic surgery, which

reconstructs the skin and reconstructs the skin and underlying structuresunderlying structures

Collaborative Management Collaborative Management AssessmentAssessment

History and data collectionHistory and data collection AgeAge Drugs and substance useDrugs and substance use Medical history, including cardiac Medical history, including cardiac

and pulmonary historiesand pulmonary histories Previous surgery and anesthesiaPrevious surgery and anesthesia Blood donationsBlood donations Discharge planningDischarge planning

Physical Assessment/Clinical Physical Assessment/Clinical ManifestationsManifestations

Obtain baseline vital signs.Obtain baseline vital signs. Focus on problem areas Focus on problem areas

identified by the client’s history identified by the client’s history on all body systems affected by on all body systems affected by the surgical procedure.the surgical procedure.

Report any abnormal assessment Report any abnormal assessment findings to the surgeon and to findings to the surgeon and to anesthesiology personnel.anesthesiology personnel.

System AssessmentSystem Assessment

Cardiovascular systemCardiovascular system Respiratory systemRespiratory system Renal/urinary systemRenal/urinary system Neurologic systemNeurologic system Musculoskeletal systemMusculoskeletal system Nutritional statusNutritional status Psychosocial assessmentPsychosocial assessment

Laboratory AssessmentLaboratory Assessment UrinalysisUrinalysis Blood type and crossmatchBlood type and crossmatch Complete blood count or Complete blood count or

hemoglobin level and hematocrithemoglobin level and hematocrit Clotting studiesClotting studies Electrolyte levelsElectrolyte levels Serum creatinine levelSerum creatinine level Pregnancy testPregnancy test Chest x-ray examinationChest x-ray examination ElectrocardiogramElectrocardiogram

Deficient Knowledge Deficient Knowledge InterventionsInterventions

Preoperative teachingPreoperative teaching Informed consentInformed consent

The surgeon is responsible for The surgeon is responsible for obtaining signed consent before obtaining signed consent before sedation is given and surgery is sedation is given and surgery is performed.performed.

The nurse’s role is to clarify facts The nurse’s role is to clarify facts presented by the physician and presented by the physician and dispel myths that the client or dispel myths that the client or family may have about surgery.family may have about surgery.

Implementing Dietary Implementing Dietary RestrictionsRestrictions

Client is given nothing by mouth Client is given nothing by mouth (NPO) for 6 to 8 hours before (NPO) for 6 to 8 hours before surgery.surgery.

NPO status decreases the risk NPO status decreases the risk for aspiration.for aspiration.

Failure to adhere can result in Failure to adhere can result in cancellation of surgery or cancellation of surgery or increase the risk for aspiration increase the risk for aspiration during or after surgery.during or after surgery.

Administering Regularly Administering Regularly Scheduled MedicationsScheduled Medications

Consult the medical physician Consult the medical physician and anesthesia provider for and anesthesia provider for instructions about drugs, such as instructions about drugs, such as those taken for diabetes, cardiac those taken for diabetes, cardiac disease, glaucoma, regularly disease, glaucoma, regularly scheduled anticonvulsants, scheduled anticonvulsants, antihypertensives, antihypertensives, anticoagulants, antidepressants, anticoagulants, antidepressants, or corticosteroids.or corticosteroids.

Intestinal PreparationIntestinal Preparation

Bowel or intestinal preparations Bowel or intestinal preparations are performed to prevent injury are performed to prevent injury to the colon and to reduce the to the colon and to reduce the number of intestinal bacteria.number of intestinal bacteria.

Enema or laxative may be Enema or laxative may be ordered by the physician.ordered by the physician.

Skin PreparationSkin Preparation

The skin is the body’s first line of The skin is the body’s first line of defense against infection; a defense against infection; a break in the barrier increases break in the barrier increases the risk for infection.the risk for infection.

Shower using antiseptic solution.Shower using antiseptic solution. Shaving as a procedure before Shaving as a procedure before

surgery is viewed as surgery is viewed as controversial.controversial.

Preparing the ClientPreparing the Client

Possible placement of tubes, Possible placement of tubes, drains, and vascular access devicesdrains, and vascular access devices

Teaching about postoperative Teaching about postoperative procedures and exercises:procedures and exercises: Breathing exercises, incentive Breathing exercises, incentive

spirometry, coughing and splintingspirometry, coughing and splinting

(Continued)(Continued)

Preparing the ClientPreparing the Client (Continued)(Continued)

Leg procedures and exercises, Leg procedures and exercises, antiembolism stockings and elastic antiembolism stockings and elastic wraps, early ambulation, and range-wraps, early ambulation, and range-of-motion exercisesof-motion exercises

DEEP BREATHING, COUGHING, DEEP BREATHING, COUGHING, LEG EXERCISESLEG EXERCISES

Deep breathing is a form of controlled ventilation that Deep breathing is a form of controlled ventilation that opens and fills small air passages in the lungs to opens and fills small air passages in the lungs to prevent atelectasis and pneumonia.prevent atelectasis and pneumonia.

Coughing is a natural method of clearing secretions Coughing is a natural method of clearing secretions from the airways.from the airways.

Leg exercises help promote circulation and reduce the Leg exercises help promote circulation and reduce the risk of forming a thrombus in the veins.risk of forming a thrombus in the veins.

Antiembolism stockings help prevent thrombi and Antiembolism stockings help prevent thrombi and emboli by compressing superficial veins and emboli by compressing superficial veins and capillaries redirecting blood to larger and deeper capillaries redirecting blood to larger and deeper veins, where it flows more effectively toward the veins, where it flows more effectively toward the heart.heart.

DEEP BREATHING & COUGHINGDEEP BREATHING & COUGHING

LEGS EXERCISESLEGS EXERCISES

Anxiety InterventionsAnxiety Interventions

Preoperative teachingPreoperative teaching Encouraging communicationEncouraging communication Promoting restPromoting rest Using distractionUsing distraction Teaching family and significant Teaching family and significant

othersothers

Preoperative Chart ReviewPreoperative Chart Review

Ensure all documentation, Ensure all documentation, preoperative procedures, and preoperative procedures, and orders are complete.orders are complete.

Check the surgical consent form Check the surgical consent form and others for completeness.and others for completeness.

Document allergies.Document allergies. Document height and weight.Document height and weight.

(Continued)(Continued)

Preoperative Chart ReviewPreoperative Chart Review

(Continued)(Continued)

Ensure results of all laboratory Ensure results of all laboratory and diagnostic tests are on the and diagnostic tests are on the chart.chart.

Document and report any Document and report any abnormal results.abnormal results.

Report special needs and Report special needs and concerns.concerns.

Preop Client PrepPreop Client Prep

Client should remove most Client should remove most clothing and wear a hospital clothing and wear a hospital gown.gown.

Valuables should remain with Valuables should remain with family member or be locked up.family member or be locked up.

Tape rings in place if they can’t Tape rings in place if they can’t be removed.be removed.

Remove all pierced jewelry.Remove all pierced jewelry.(Continued)(Continued)

Preop Client PrepPreop Client Prep (Continued)(Continued)

Client wears an identification band.Client wears an identification band. Dentures, prosthetic devices, Dentures, prosthetic devices,

hearing aids, contact lenses, hearing aids, contact lenses, fingernail polish, and artificial nails fingernail polish, and artificial nails must be removed.must be removed.

Preoperative MedicationPreoperative Medication

Reduce anxiety.Reduce anxiety. Promote relaxation.Promote relaxation. Reduce pharyngeal secretions.Reduce pharyngeal secretions. Prevent laryngospasm.Prevent laryngospasm. Inhibit gastric secretion.Inhibit gastric secretion. Decrease amount of anesthetic Decrease amount of anesthetic

needed for induction and needed for induction and maintenance of anesthesia.maintenance of anesthesia.

PREOPERATIVE MEDICATIONSPREOPERATIVE MEDICATIONS ANTICHOLINERGICS: Glycopyrrolate (robinal) decreases ANTICHOLINERGICS: Glycopyrrolate (robinal) decreases

respiratory secretions.respiratory secretions. ANTIANXIETY: Lorazepam (ativan) reduces anxiety.ANTIANXIETY: Lorazepam (ativan) reduces anxiety. HISTAMINE-2 RECEPTOR ANTAGONIST: Cimetidine HISTAMINE-2 RECEPTOR ANTAGONIST: Cimetidine

(tagamet) decreases gastric acidity and volume.(tagamet) decreases gastric acidity and volume. NARCOTICS: Demerol (meperidine) decreases the amount NARCOTICS: Demerol (meperidine) decreases the amount

of anesthesia needed to sedate the client.of anesthesia needed to sedate the client. SEDATIVES: Midazolam (versed) promotes sleep or SEDATIVES: Midazolam (versed) promotes sleep or

conscious sedation and decrease anxiety.conscious sedation and decrease anxiety. ANTIBIOTICS: Kanamycin (Kantrex) destroy enteric ANTIBIOTICS: Kanamycin (Kantrex) destroy enteric

microorganisms.microorganisms.