Pre-operative Nursing Care

Pre-operative nursing care is health care delivered before to a surgical procedure. The goal of pre-operative nursing care is to do everything possible to ensure the success of the surgery. The person's fitness for surgery will be evaluated by the health care practitioner prior to operation. This evaluation should include whatever tests are required, but not screening for conditions that are not indicated. Immediately before surgery, the person's body is prepared, sometimes by washing with antiseptics, and their worry is addressed wherever feasible to make them comfortable.

Purposes

• In order to reassure the patient
• To safeguard the operation patient against infection, exposure, and accident in whatever way feasible.
• To avoid the possibility of a legal point of view

Role of Nurses in the Pre-operative Phase

• Pre -operative assessment

• Obtaining informed consent

• Pre -operative teaching

• Physical preparation of patient

• Psychological preparation of patient

Pre -operative assessment

A. Review pre -operative laboratory and diagnostic

• A complete blood count, blood type and cross-match, serum electrolytes, urinalysis, a chest x-ray, and an electrocardiogram are all performed.

• Other tests relating to the procedure or the client's medical condition, such as prothrombin time, partial thromboplastin time, blood urea, creatinine, and radiographic investigations, may be performed.

B. Review the client's health history

• The current illness's history and the cause for surgery

• Past medical history, medical condition (acute and chronic), previous hospitalization and surgeries, history of any previous anesthesia problems, allergies, current medications

• Alcohol, tobacco, and drug abuse

• System evaluation

C. Assess physical needs

• Factors to evaluate include communication ability, vital signs, level of consciousness, bewilderment, drowsiness, unresponsiveness, weight, and height.

• Ability to move around/ambulate

• The amount of exercise

• The state of circulation

D. Assess psychological needs

• Communication skills, vital signs, degree of consciousness, perplexity, drowsiness, unresponsiveness, weight, and height are all factors to consider.

• Mobility/ambulation ability

• The quantity of exercise The current state of circulation

E. Assess cultural needs

• Language needs for interpretation

Obtaining informed consent

• The client must sign a surgical permission form or an operation authorization before to surgery.

• Clients must sign a permission document before any surgery that needs anesthesia and has the potential for complications.

• If the client is under the age of 18, the consent form must be signed by a parent or legal guardian.

• In an emergency, the surgeon may be forced to operate without consent; however, health care staff make every effort to get consent via phone or fax.

• Each nurse must be knowledgeable with agency regulations as well as state legislation pertaining to surgical permission forms.

• Before getting any preoperative sedatives, the client must sign a consent document.

Pre -operative teaching

• It is best to teach clients about their surgical procedures and expectations before and after surgery during the preoperative period.

• At this time, the client is more alert and pain-free.

• The information in the pre-operative teaching plan varies depending on the type of surgery and length of hospitalization.

Physical Preparation of Patient

Preoperative preparation includes the following areas:

• Nutrition and fluids: Adequate hydration and nutrition promote healing, usually NPO after midnight
• Elimination: Enemas may be ordered if bowel surgery is planned, prior to surgery and surgery an indwelling Foleys catheter may be ordered to ensure that bladder remains empty. This helps prevent injury to the bladder, particularly during pelvic surgery.
• Hygiene: Clients are asked to bath or shower the evening or morning of surgery. The purpose of the hygienic measure is to reduce the risk of wound infection by reducing the number of bacteria on the client’s skin. The nail should be trimmed.
• Medications: Commonly used preoperative medication includes: antiemetics, anticholinergics, sedatives, antibiotics
• Sleep: Adequate sleeps helps the client manage the stress of surgery and helps healing.
• Care of valuables: Jewelry or money should be sent home with the client's family or significant others or locked storage area per the agency policy.
• Prostheses: All prosthesis such as a partial or complete denture, contact lens, artificial eyes, and artificial limbs and eye glasses, wigs.
• Special orders: Check the surgeon order for special requirement (e.g. the insertion of the nasogastric tube prior to the surgery, the administration of medications such as insulin, or the application of anti-embolic stockings.
• Surgical skin preparation: The surgical site is cleaned with an antimicrobial to remove the resident microbial count to sub pathogenic level. Remove the hair at the site of surgery.
• Surgical protocols: Identifying the patient and surgery to be performed. Surgical site marking.
• Vital signs: The nurse report any abnormal findings such as elevated blood pressure or elevated temperature.
• Anti-embolic stockings: Anti-embolic stocking is a firm elastic hose that compresses the vein of the legs and thereby facilities the return of venous blood to the heart.

Psychological preparation

• Pre-operative education can help clients overcome their fears and anxieties.