Preoperative care for nurses

1. Perioperative nursing

3. PRE OPERATIVE PHASE
 Preoperative: begins with the decision to perform surgery
and continues until the client has reached the operating area.

4. Nursing assessment of preoperative
patient
 The overall goal of the preoperative assessment is to identify
risk factors and plan care to ensure patient safety
throughout the surgical experience.
 Establish baseline data for comparison in the intraoperative
and postoperative period.
 Determine the patient’s psychologic status to reinforce the
use of coping strategies during the surgical experience.
 Determine physiologic factors directly or indirectly related
to the surgical procedure that may contribute to operative
risk factors.

5.  Participate in the identification and documentation of the
surgical site according to protocol.
 Identify prescription drugs, over-the-counter (OTC) drugs,
and herbs taken by the patient that may result in drug
interactions affecting the surgical outcome.
 Review the results of all preoperative diagnostic studies in
the patient’s record and share this information with the
appropriate HCPs.
 Identify cultural and ethnic factors that may affect the
surgical experience.
 Determine if the patient received adequate information from
the surgeon to make an informed decision to have surgery
and that the consent form is signed and witnessed

6.  Your 19-yr-old male patient is in the holding area. He is
scheduled for an orchiectomy for testicular cancer. He is
visibly sweating and agitated. When you ask him how he is
doing, he responds, “I am scared. Wouldn’t you be?”
 What can you do to reduce his fear?

7. 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.

8. 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
 Substance use: alcohol, tobacco, drugs
 Review of system

9. Assess physical needs
 Ability to communicate
 Vital signs
 Level of consciousness < Confusion , Drowsiness
unresponsiveness
 Weight and height
 Ability to move/ ambulate •Level of exercise
 Prostheses
 Circulatory status

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

11. 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.

12.  In an emergency, the surgeon may have to operate without
consent, health care personnel, however, makes every effort
to obtain consent by telephone.
 Each nurse must be familiar with 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).

13. 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.
 Information in a preoperative teaching plan varies with the
type of surgery and the length of the hospitalization.

14. Teaching
 Educate on:
 Preoperative medication.
 Post operative pain control.
 Discussion of the frequency of assessing vital signs and use of
monitoring equipment.
 Explanation and demonstration
 Deep breathing and coughing exercises
 Use of incentive spirometry
 How to support the incision for breathing exercises and moving
 Position changes
 Feet and leg exercises.
 Postoperative IV lines and tubings ex: NG tube