Preoperative Period
Tubes
Drains
Vascular access
Nasogastric Tube
Prevention of Respiratory
Complications
Breathing exercises
Incentive spirometry
Coughing and splinting
Decreased:
Increased:
Blood pressure
Risk for skin damage, infection
Sensory deficits
Deformities related to osteoporosis/arthritis
Chronic illness
Malnutrition
Impaired self-care ability
Allergies
Inadequate support systems
Urgency:
Elective
Urgent
Emergent
Degree of Risk:
Minor
Major
10
Extent of Surgery
Simple
Radical
Minimally invasive (MIS)
11
Anxiety Interventions
Preoperative teaching
Encourage communication
Promote rest
Use distraction
Teach family members
12
Skin Preparation
13
Preoperative Drugs
Reduce anxiety
Promote relaxation
Reduce nasal and oral secretions
14
Prevent laryngospasm
Reduce vagal-induced bradycardia
Inhibit gastric secretion
Decrease amount of anesthetic needed for
induction and maintenance of anesthesia
15
Collaborative Management:
Assessment
Age
Drugs, substance use
Medical history (including cardiac and pulmonary)
Complementary/alternative practices
Previous surgical procedures, anesthesia
Blood donations
Discharge planning
16
Physical Assessment/Clinical
Manifestations
17
System Assessment
Cardiovascular
Respiratory
Renal/Urinary
18
Neurologic
Musculoskeletal
Nutritional status
Determine baseline
Assess LOC, ability to follow commands
Psychosocial
19
Prevention of Cardiovascular
Complications
20
Laboratory Assessment
Urinalysis
Blood type and crossmatch
CBC or hemoglobin level and hematocrit
Clotting studies (PT, INR, aPTT)
21
Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray
ECG
22
Preoperative teaching
Informed consent:
23
Informed Consent
24
25
26
Cardiac disease
Respiratory disease
Seizures
Hypertension
27
Intestinal Preparation
28
29
Obese patients
Age 40 or older
History of cancer
Decreased mobility or immobile
Spinal cord injury
30
31
32
33
34
35
Remove:
Dentures
Prosthetic devices
Hearing aids
Contact lenses
Fingernail polish
Artificial nails
Pierced jewelry
36
Sedatives
Hypnotics
Anxiolytics
Opioid analgesics
Anticholinergic agents
H2 histamine blockers
37
Chapter 16
38
Question 1
To ensure safe patient care transition from the perioperative nurse
to the intraoperative nurse, optimal hand-off communication
includes all of the following except:
A.
B.
C.
D.
39
Question 2
When assessing the laboratory work of a 65-year-old
patient who is scheduled for surgery this morning, which
laboratory value may result in cancellation of the
surgery?
A.
B.
C.
D.
40
Question 3
During a preoperative assessment, the nurse asks the
patient about allergies. Which allergy cited by the
patient would be of greatest concern during the surgical
procedure?
A.
B.
C.
D.
Shellfish
Sulfa drugs
Codeine
Kiwi
41