Preoperative phase
•Begins at the time of decision for surgery and ends when the client is transferred to the OR
•This period is used to prepare the client for surgery (physically and psychologically
•The nurse plays a major role in client teaching and in relieving the client’s and the family’s anxieties
Steps Before Surgery (preoperative)
1-“Informed Consent”,
SurgicalConsent
2-Psychological Prepartion
3-Physiologic Preparation Prior to Surgery:
Obtain history of past medical conditions, allergies,dietary restrictions, and medications:
A –Allergy to medications, chemicals, and other environmental products such as latex
•All allergies are reported to anesthesia and surgical personnel before the beginning of surgery
•If allergy exist, an allergy band must be placed in the client’s arm immediately
B-Bleeding tendencies or the use of medications that determine clotting, such as aspirin, heparin, and warfarin sodium.
•Herbal medications may also increase
bleeding time or mask potential blood-related problems
C–Drug and alcohol abuse (Cortisone and steroid)
D –Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but also known to delay wound healing
E –Emboli; previous embolic events ( such as lower leg blood clots) may recur because of prolonged immobility
F- Malnutrition,smoking,obesity,low Hb and RBC,pregnancy
G- Extreme in age
Respiratory preparation: chest x-ray
Cardiovascular preparation: ECG, CBC,
blood typing, cross-matching, PT/PTT
(prothrombin time, partial
thromboplastin time), serum
electrolytes Renal preparation: urinalysis
4-Physical Preparation
On the Night of the Surgery:
•Preparing the client’s skin: shave against the grain of the hair shaft to ensure clean and close shave
•Preparing the GIT:
•NPO after midnight
•Administration of enema may be necessary
•Insertion of gastric or intestinal tubes
•Preparing for Anesthesia
•Promoting rest and sleep: use of drugs
On the Day of the Surgery:
•Early morning care: about 1 hour •before the pre-operative medication schedule
•Vital signs taken and recorded promptly
•Patient changes into hospital gown that is left untied
and open at the back
•Braid long hair and remove hair pin
•Provide oral hygiene
•Prosthetic devices, eyeglasses, dentures removed
•Remove jewelries and polish
•Patient should void immediately before going to the OR
•Make sure that the patient has not taken food for the
last 10 hours by asking the client
5-Pre-Operative Medications
Generally administered 60-90 min before induction of anesthesia surgery
types of Pre-Operative Medications:
Sedative:
promotes sleep and decrease anxiety e.g.Midazolam
Anticholinergics :decrease respiratory secretions e.g. Glycopyrrolate
Antianxiety :reduce anxiety e.g. Lorazepam
Narcotics :decrease the amount of anesthesia needed in OR e.g. Demerol
Antibiotic :destroy enteric microorganisms e.g. Kanamycin
6-Preoperative checklist
•History and physical examination
•Name of procedure on consent and signed
•Lab results
•Identification band
•Allergies have been identified
•NPO
•Skin preparation completed
7-Diagnosis
•Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery
•Fear related to perceived threat of the surgical procedure and separation from support system
•Knowledge deficit of preoperative procedures and protocols and postoperative expectations
•High risk for post operative complibleeding bleeding, infection, thrombosis, respiratory problems…etc. (see post operative care)
•Begins at the time of decision for surgery and ends when the client is transferred to the OR
•This period is used to prepare the client for surgery (physically and psychologically
•The nurse plays a major role in client teaching and in relieving the client’s and the family’s anxieties
Steps Before Surgery (preoperative)
1-“Informed Consent”,
SurgicalConsent
2-Psychological Prepartion
3-Physiologic Preparation Prior to Surgery:
Obtain history of past medical conditions, allergies,dietary restrictions, and medications:
A –Allergy to medications, chemicals, and other environmental products such as latex
•All allergies are reported to anesthesia and surgical personnel before the beginning of surgery
•If allergy exist, an allergy band must be placed in the client’s arm immediately
B-Bleeding tendencies or the use of medications that determine clotting, such as aspirin, heparin, and warfarin sodium.
•Herbal medications may also increase
bleeding time or mask potential blood-related problems
C–Drug and alcohol abuse (Cortisone and steroid)
D –Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but also known to delay wound healing
E –Emboli; previous embolic events ( such as lower leg blood clots) may recur because of prolonged immobility
F- Malnutrition,smoking,obesity,low Hb and RBC,pregnancy
G- Extreme in age
Respiratory preparation: chest x-ray
Cardiovascular preparation: ECG, CBC,
blood typing, cross-matching, PT/PTT
(prothrombin time, partial
thromboplastin time), serum
electrolytes Renal preparation: urinalysis
4-Physical Preparation
On the Night of the Surgery:
•Preparing the client’s skin: shave against the grain of the hair shaft to ensure clean and close shave
•Preparing the GIT:
•NPO after midnight
•Administration of enema may be necessary
•Insertion of gastric or intestinal tubes
•Preparing for Anesthesia
•Promoting rest and sleep: use of drugs
On the Day of the Surgery:
•Early morning care: about 1 hour •before the pre-operative medication schedule
•Vital signs taken and recorded promptly
•Patient changes into hospital gown that is left untied
and open at the back
•Braid long hair and remove hair pin
•Provide oral hygiene
•Prosthetic devices, eyeglasses, dentures removed
•Remove jewelries and polish
•Patient should void immediately before going to the OR
•Make sure that the patient has not taken food for the
last 10 hours by asking the client
5-Pre-Operative Medications
Generally administered 60-90 min before induction of anesthesia surgery
types of Pre-Operative Medications:
Sedative:
promotes sleep and decrease anxiety e.g.Midazolam
Anticholinergics :decrease respiratory secretions e.g. Glycopyrrolate
Antianxiety :reduce anxiety e.g. Lorazepam
Narcotics :decrease the amount of anesthesia needed in OR e.g. Demerol
Antibiotic :destroy enteric microorganisms e.g. Kanamycin
6-Preoperative checklist
•History and physical examination
•Name of procedure on consent and signed
•Lab results
•Identification band
•Allergies have been identified
•NPO
•Skin preparation completed
7-Diagnosis
•Anxiety related to the surgical experience (anesthesia, pain) and the outcome of surgery
•Fear related to perceived threat of the surgical procedure and separation from support system
•Knowledge deficit of preoperative procedures and protocols and postoperative expectations
•High risk for post operative complibleeding bleeding, infection, thrombosis, respiratory problems…etc. (see post operative care)
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