Pre-operative Care

Pre-Operative Care

Pre-operative care is the preparation and management of a patient prior to surgery. It means the care given to a patient at the time of the decision for surgery to the time the patient is shifted onto the operation theater. It includes both physical and psychological preparation. Patients who are physically and psychologically prepared for surgery tend to have better surgical outcomes. Pre-operative care is extremely important prior to any invasive procedure, regardless of whether the procedure is minimally invasive or a form of major surgery.

Purposes

• To prepare the patient psychologically and physically for anesthesia and surgery.
• To help the patient feel comfortable and relaxed about surgery.
• To prevent post-operative complications.
• To teach the patient about health exercises they may need to do after surgery.

Equipment

• Shaving set
• Soap and water
• Brush or comb
• Thermometer tray
• BP apparatus
• Clean cotton gown
• Kidney tray
• Pre-operative consent form and other admission form
• Pre-operative check list
• Medicine with medication cardex

Pre-operative Preparation

Pre-up care includes the following:

• Physiological preparation: collection of all the relevant information
• Psychological care
• Operation consent (legal aspects)
• Physical preparation of skin, intestine, and other organs
• Pre-operative teaching
• Pre-medication
• Proper documentation of discussions, tests and procedures undertaken

Physiological Preparation

Physiological preparation includes collection of all the relevant information. It may consist of a complete medical history and physical exam, including the patient's surgical and anesthesia background. The patient should inform the physician and hospital staff if he or she has ever had an adverse reaction to anesthesia. The scope of nursing activities during this period includes establishing baseline evaluation of the patient before the day of carrying out a preoperative interview and assessment which includes:

• Obtaining health history and performing physical examination to establish base line data.
• Determining psychological status of patient and Emotional assessment (mental status) like anxiety, depression, psychosis etc.
• Determining physiological factors that are directly or indirectly related to the surgical procedure that may contribute to operative risk factors.
• Identifying previous operative and anesthetic history
• Conformation reports all preoperative tests. Such as laboratory test, ECG for cardiac condition, x-ray.
• Identification of known allergies and genetic problems.
• Identifying present problem requiring surgery and past medical and surgical history which may influence anesthesia and surgery e. g. cardiovascular disease, neurological, renal, and gastrointestinal.
• Finding family history of chronic disease.
• Level of education, economic condition and level of understanding etc.
• Identifying cultural and ethnic factors that may affect surgical experiences
• Performing general physical examination, which includes general appearance of the patient, weight, and vital sings like temperature, pulse, respiration and blood pressure, etc.

Psychological Care

It is the preparation of the patient and his/her family emotionally. Of course, explanation and teaching are key words in the psychological preparation of the patient for surgery.

Anxiety is a big problem for the patient facing surgery. The most important causes of anxieties are:

• Fear of unknown
• Fear of death or disability
• Fear of pain, fear of poor prognosis
• Fear of losing job, financial insecurity
• Fear of losing his social and family role
• Fear of hindrance in cultural, spiritual and religious beliefs

Reduce the patient's anxiety and fear preoperatively in the following ways:

• Welcome the patient warmly and maintain a positive relationship with them.
• Introduce the hospital's routines, visiting hours, mealtimes, etc. to the patient and their family.
• To determine the real or prospective cause of the patient's anxiety, evaluate the patient's psychological condition.
• Create and maintain a therapeutic alliance.
• Tell the patient about various procedures like X-rays, USG, and lab tests.
• Give the patient every chance to express his anxieties and to ask questions.
• Pay attention to any concerns the patient may have about the procedure.
• Boost patient confidence.
• If the patient has any possible misunderstandings, clear them up and keep providing emotional support.
• Describe the standard operating procedures and preparation steps.
• Allow the patient to meet and converse with other patients who have recovered successfully from comparable surgery.
• Before being escorted to the operating room, let the patient's loved ones visit with him or her.
• Avoid having too many guests since they could prevent the patient from getting enough rest.
• Warm up the patient, especially in the winter.
• Respect the patient's culture, religion, and personal beliefs; if necessary, permit visitors.
• Children in particular may experience terror. As long as the parent isn't visibly afraid and adding to the child's anxiety, they should be permitted to have a parent around them as much as feasible. On the day of surgery, parents should encourage their children to bring a special blanket or toy with them to the hospital.

Obtaining Operation Consent (Legal Aspects)

Any patient undergoing a surgical procedure, whether it is major or minor, must sign an operation permit (consent for operation). This means an informed written consent which means that the patient undergoing surgery must know about nature of disease, operative procedure, prognosis, complications and possible modes of treatment. An adult patient can sign his own consent for operation but Patients who are mentally impaired, heavily sedated, or critically ill are not considered legally able to give consent. In that circumstance, a relative or guardian may sign for the patient. Children under age 18 must have a parent or guardian sign. High-risk consent must be taken for the second time from the patient whose operation is going under critical condition or having amputation of any part of the body.

• Get the consent signed by the patient or the responsible relatives for children and od unconscious patients.
• If the patient and the patient's relatives are unable to read the consent form, please read it to them and get it signed.
• Do not force them.
• If the patient and relatives are unable to write, they could consent by putting finger prints.
• In the absence of relatives, the hospital authority could consent for emergency surgery.
• Check whether the signed operative permit is attached to the chart when the patient goes to the operating room.

Pre-Operative Teaching

Pre-operative teaching includes instruction about the preoperative period, the surgery itself, and the postoperative period. Pre-operative teaching meets the patient's need for information regarding the surgical experience, which in turn may alleviate most of his or her fears. Pre- operative teaching must be individualized for each patient. Some people want as much information as possible, while others prefer only minimal information because too much knowledge may increase their anxiety. Patients have different abilities to comprehend medical procedures; some prefer printed information, while others learn more from oral presentations. It is important for the patient to ask questions during preoperative teaching sessions. Pre-operative teaching for patients undergoing surgery includes instruction about:

Preoperative Period

• Instruction about the arrival time, where the patient should go on the day of surgery and how to prepare for surgery. For example, patients should be told how long they should be NPO, which medications to take prior to surgery, and the medications that should be brought with them (such as inhalers for patients with asthma).

Surgery Period

• Instruction about the surgery itself includes informing the patient about what will be done ald bos also during the surgery, and how long the procedure is expected to take. The patient should be told where the incision will be.
• Children having surgery should be allowed to "practice" on a doll or stuffed animal. It may be helpful to demonstrate procedures on the doll prior to performing them on the child.
• It is also important for family members (or other concerned parties) to know where to wait during surgery, when they can expect progress information, and how long it will be before they can see the patient.

Post-operative Period

• Knowledge about what to expect during the postoperative period is one of the best ways to improve the patient's outcome.
• Instruction about expected activities can also increase compliance and help prevent complications.
• This includes the opportunity for the patient to practice coughing and deep breathing exercises, use an incentive spirometer, and practice splinting the incision.
• Additionally, the patient should be informed about early ambulation (getting out of bed).
• The patient should also be taught that the respiratory interventions decrease the occurrence of pneumonia, and that early leg exercises and ambulation decrease the risk of blood clots.
• Patients hospitalized postoperatively should be informed about:
  • The diet pattern that have to follow after operation
  • Tubes and equipment that they will have. These may include multiple intravenous lines, drainage tubes, dressings, and monitoring devices.
  • In addition, they may have sequential compression stockings on their legs to prevent blood clots until they start ambulating.

Pain Management

• Pain management is the primary concern for many patients having surgery.
• Preoperative instruction should include information about the pain management method that they will utilize postoperatively.
• Patients should be encouraged to ask for or take pain medication before the pain becomes unbearable, and should be taught how to rate their discomfort on a pain scale.
• This instruction allows the patients, and others who may be assessing them, to evaluate the pain consistently.
• If they will be using a patient-controlled analgesia pump, instruction should take place during the preoperative period.
• Use of alternative methods of pain control (distraction, imagery, positioning, mindfulness meditation, music therapy) may also be presented.

Finally, the patient should understand long-term goals such as when he or she will be able to eat solid food, go home, drive a car, and return to work.

Physical Preparation

If the surgical procedure is elective, there is time for complete physical preparation. Here are some points to consider:

• Give by taking a bath and taking care of your hair.
• Skin preparation: Preoperative skin preparation aims to reduce microorganisms without causing damage to the skin. Elective clippers are used to safely remove hair before surgery if it needs to be done.
• Before surgery, empty the bladder and bowels.
• The diet should be ordered. In accordance with GA, liquids may be consumed up until midnight; thereafter, nothing may be taken orally. Give the patient instructions to avoid eating and drinking for at least eight hours before to operation. He can be given a small breakfast and fluids up to six hours before the surgery if it will be done under spinal anaesthetic.
• After dinner, you should order a sedative and laxative.
• Give the relative the patient's jewelry after removing it.
• Care for your mouth and take out your fake teeth.
• Request that the patient take off any prosthetics or contacts.
• To check the nail bed for signs of hypoxia, ask the patient to remove their nail polish.
• Implement the special order, such as placing an IV line, Royle's tube, or catheterizing the patient.
• Keep an eye on the patient's vital signs and let the doctors know if anything changes.
• In accordance with the anesthetic order, administer the proper premedications.
• If you can't get the nose ring or phuli off, put adhesive on them.
• Change into a comfortable, spotless cotton dress.
• Wrap a wristband with an identification card around the patient.
• Complete the pre-operative check list and check off each item that was done for the patient.
• Place the identification slip that lists the patient's name, diagnosis, procedure, age, sex, date of admission, ward, and attending physician's name.
• Request the patient to urinate before sending them to the operating room with their medical records, including the X-ray, ECG, investigation results, medications, and other necessary supplies.
• Take note of the report.

Proper Documentation of Discussions, Tests and Procedures Undertaken

Charting Includes:

• Departure of the patient's time
• Wearing an identification bracelet
• Vital signs
• Assess for allergy
• Informed constant
• Complete history and physical examination
• Final pre-operative checklist is completed or not
• Time of voiding
• Jewellery, contact leans and dentures removed and stored
• Pre-medication given: dosage, route, time
• Collection of laboratory results and other diagnostic findings
• Any special procedure carried out e.g. NG tube, catheter
• Patient's weight

Pre-operation Check List

         Identification data

Name-------- Sex-------- IP No.--------

Age-------- Bed No.-------- Ward--------

Diagnosis-------- Height--------  Weight--------

                                                Signatures:              Date and Time:

Ward sister/supervisor            ---------------               ---------------     

On duty nursing staff               ---------------               ---------------

Nursing student                       ---------------                ---------------

                                            Signature                Date and Time

Nursing student                  ---------------                 ---------------

Staff nurse                          ---------------                 ---------------

Ward sister/supervisor        ---------------                 ---------------