2.3 Preoperative Nursing Care
The preoperative surgical period refers to the phase of client care that occurs before a surgical procedure. It is a critical time when health care professionals, including nurses, play a crucial role in preparing clients physically and emotionally for surgery. The preoperative period begins when the client is scheduled for surgery and ends at the time of transfer to the surgical suite. During this time, the nurse serves as an educator, advocate, and promoter of health and safety. The nurse ensures a culture of safety by implementing evidence-based practices, adhering to protocols, and maintaining open communication with the client and the health care team.[1],[2],[3]
As an educator, the nurse reinforces information already provided to the client by the surgeon regarding the surgical procedure, potential risks and benefits, preoperative preparations, and postoperative expectations. By reinforcing this information, the nurse ensures the client understands the reason for the surgery and addresses any concerns or questions they may have. By empowering the client with knowledge, the nurse promotes active participation in decision-making and ensures informed consent. If the nurse does not believe the client has provided adequate informed consent, the surgeon should be notified before the procedure occurs. If a power of attorney (POA) for health care has been activated, the POA should be contacted for informed consent.[4],[5],[6]
The nurse also acts as an advocate for the client, ensuring their rights, preferences, and safety are respected throughout the perioperative period. This involves advocating for proper client identification, verifying surgical site marking, and ensuring that all necessary safety measures are in place. The nurse collaborates with the interdisciplinary team to address any potential risks or complications and advocates for the client’s best interests.[7],[8],[9]
Communication and collaboration are essential within the health care team, as emphasized by The Joint Commission’s National Patient Safety Goals (NPSG). The nurse actively participates in effective communication and collaboration by sharing relevant client information, clarifying orders, and addressing any potential gaps or discrepancies. This promotes teamwork, enhances client safety, and facilitates seamless transitions between different phases of care.[10],[11],[12]
Applying the Nursing Process to Preoperative Care
The following are the nursing priorities during the preoperative surgical period[13]:
- Perform preoperative assessments to evaluate the client’s overall health status and identify potential risks or contraindications for surgery.
- Collaborate with the health care team to develop a comprehensive perioperative plan for the client, including preoperative preparation and postoperative care.
- Provide health teaching about the surgery/procedure, expected outcomes, and postoperative recovery process.
- Ensure informed consent is obtained prior to administration of preoperative medication administration and the surgical procedure.
- Administer preoperative medications as prescribed, such as premedication for anxiety or prophylactic antibiotics.
Assessment
Preoperative Health History
The nurse assesses many factors as the client is prepared for surgery to ensure safety and optimize their surgical outcomes. A preoperative health history includes the following components[14],[15][16]:
- Age: The client’s age is an important factor to consider, as it can impact their physiological response to surgery. Older adults have increased risk of surgical complications due to factors such as delayed immune system response, delayed wound healing, delayed renal excretion, decreased muscle mass, increased risk of dehydration, and decreased physiological reserve. It is important to assess these factors and take appropriate measures to mitigate the associated risks. Pediatric clients will require reduced dosages of anesthetic agents, may require specialized equipment due to reduced size, and will require different communication techniques and familiar support when transitioning into the surgical environment. Utilizing child life specialists (when available) to familiarize pediatric clients to the sights and sounds associated with the operating room can be very beneficial in reducing anxiety. Child life specialists are members of the health care team who work with children and their families to provide education and preparation during hospitalization.
- Drugs and substance use: A comprehensive medication history should be obtained, including prescription and over-the-counter (OTC) medications, supplements, and substance use. It is crucial to identify medications or substances that may interfere with anesthesia and clotting or increase the risk of complications during and after surgery. Special attention should be given to substances such as tobacco, alcohol, and marijuana, as they can have significant effects on the client’s respiratory and cardiovascular systems.
- Medical history, particularly cardiac and pulmonary conditions: The client’s medical history, particularly cardiac and pulmonary conditions, should be thoroughly evaluated. Clients with cardiac disease are at a higher risk of anesthesia-related complications and may have difficulty tolerating hemodynamic changes induced by anesthesia. For individuals at risk of cardiac complications, specific measures, such as administration of preoperative beta-blockers, may be necessary to reduce the risk of myocardial infarction (MI) during surgery. Pulmonary complications should be assessed, especially in clients with chronic obstructive pulmonary disease (COPD) or a history of smoking. Clients who smoke or have COPD may have reduced lung function, decreased gas exchange, and increased risk of anesthesia-related complications.
- History of previous surgical procedures and anesthesia: The client’s history of previous surgeries and experiences with anesthesia should be reviewed. Previous surgical procedures and anesthesia may have an impact on the client’s readiness for the current surgery. Additionally, a family history of malignant hyperthermia, a rare but life-threatening reaction to certain anesthetics, should be documented.
- Allergies: Allergies, particularly those related to anesthesia and surgical supplies, must be identified to prevent adverse effects. Common allergies include latex (found in gloves and other medical supplies) and medications related to anesthesia (such as propofol). Allergies must be communicated to the anesthesiologist and surgical team so that precautions and alternative options are considered.
- Previous blood donations: If the client has donated blood, either autologous (donating one’s own blood for later use) or directed (other donor donating blood specifically for the client’s use), this must be documented. This information is important for planning potential blood product transfusions during or after surgery. Additionally, in some cases, the client may have received erythropoietin (EPO) to stimulate red blood cell production before surgery, which can reduce the need for blood transfusions.
- Discharge planning: Preparation for surgery also involves considering the client’s postoperative care and discharge planning. The client’s home environment should be evaluated to ensure it is conducive to recovery and necessary support systems are in place. Self-care abilities should be assessed to determine if additional assistance or resources will be required after surgery. Factors such as postoperative needs, follow-up appointments, transportation, and any necessary medical equipment or supplies should also be taken into account during discharge planning.[17],[18],[19]
Read more information about performing a routine health history in the “Health History” chapter of Open RN Nursing Skills, 2e.
Preoperative Physical Assessment
The primary health care provider completes a history and physical (H&P) and orders diagnostic testing and/or consults that are needed for the client to be cleared for surgery. The nurse ensures the H&P is in the chart as part of a preoperative checklist.
A nurse may also perform a final assessment just prior to surgery. Table 2.3a provides an overview of focused nursing assessments by body system. The preoperative assessments focus on various physiological and psychosocial factors that can impact surgical outcomes.[20] If any new concerns are found, the nurse notifies the surgical team to minimize potential risks.
Table 2.3a. Key Focused Preoperative Assessments[21]
| System | Focused Assessments | Rationale |
|---|---|---|
| Cardiovascular | Check for new hypertension. | Hypertension is often undiagnosed and can affect the hemodynamic response to surgery. |
| Listen to heart sounds for rate, regularity, and abnormalities. | New abnormal heart sounds may indicate underlying cardiac conditions and increase the risk of complications. | |
| Examine the hands and feet for temperature, color, peripheral pulses, capillary refill, and edema. | Abnormalities in temperature, color, or peripheral pulses may indicate poor circulation or vascular problems. | |
| Assess for previous venous thromboembolism (VTE). | Previous VTE increases the risk of developing blood clots during surgery. | |
| Respiratory | Consider age, smoking history, and any chronic illnesses like chronic obstructive pulmonary disease (COPD). | These factors can impact respiratory function and increase the risk of complications. |
| Observe respiratory rate, rhythm, depth, and overall breathing effort. | Abnormalities in respiratory parameters may indicate underlying respiratory conditions. | |
| Document any clubbing of the fingertips or cyanosis. | Clubbing and cyanosis may suggest chronic respiratory diseases. | |
| Auscultate lungs to assess for abnormal breath sounds. | Abnormal breath sounds may indicate underlying respiratory pathologies. | |
| Assess for obesity, as it increases the risk of obstructive sleep apnea (OSA). | Obese clients have a higher risk of developing OSA during surgery or recovery. | |
| Renal | Inquire about urinary symptoms such as frequency, dysuria, nocturia, difficulty starting urine flow, and oliguria. | These symptoms may indicate underlying renal problems that can contribute to potential complications. |
| Assess appearance and odor of urine and degree of continence. | Abnormal appearance or odor of urine or incontinence may indicate infection or renal dysfunction. | |
| Evaluate usual fluid intake. | Fluid intake affects renal function. | |
| Evaluate kidney function. | Decreased kidney function decreases the excretion of drugs and anesthetic agents and can result in prolonged drug effects. | |
| Neurological | Assess overall mental status, level of consciousness (LOC), orientation, and ability to follow commands. | Baseline neurological status is important to establish for accurate postoperative assessments. |
| Determine the client’s risk for falling, especially in older adults. | Fall risk assessment helps in implementing necessary precautions. | |
| Musculoskeletal | Inquire about a history of arthritis or surgical history for joint replacements. | Joint replacements and arthritis may affect client positioning and surgical approach. |
| Assess for any unique positioning requirements (e.g., neck or chest conditions). | Unique positioning requirements should be noted to ensure client safety during surgery. | |
| Note the presence of any prosthetic joints, tattoos, and scar tissue. | Prosthetic joints, tattoos, and scar tissue can be affected by cautery, requiring additional care during surgery. | |
| Nutrition | Assess nutritional status, particularly malnutrition and obesity. Observe physical signs of malnutrition, such as brittle nails, muscle wasting, or dry or flaky skin. | Malnutrition and obesity can impact wound healing and surgical outcomes. |
Review information about assessing various body systems in Open RN Nursing Skills, 2e, including the “Cardiovascular Assessment,” “Respiratory Assessment,” “Neurological Assessment,” and “Musculoskeletal Assessment” chapters.
Preoperative Laboratory Assessment
Preoperative screening plays a crucial role in ensuring client safety and optimal surgical outcomes. A comprehensive evaluation of a client’s health status before undergoing surgery is essential to identify any underlying conditions or abnormalities that may impact the surgical procedure or pose risks during the operation. Prior to planned surgeries, the client’s primary health care provider completes a History and Physical (H&P). Its purpose is to assess overall health and screen for potential issues in regard to surgery and anesthesia.
Laboratory tests commonly performed as part of a preoperative H&P include a complete blood count (CBC), basic metabolic panel (BMP), liver function tests (LFTs), coagulation profile (PT, PTT, and INR), urinalysis (UA), and a pregnancy test for females.[22] These tests provide valuable information about the client’s blood cell counts, organ function, electrolyte balance, liver health, and clotting ability.
The nurse ensures the H&P and related preoperative lab work results are included in the client’s chart as part of the preoperative checklist. By analyzing these parameters, health care professionals evaluate a client’s overall health, detect any potential issues, and make informed decisions regarding the surgical approach, anesthesia management, and postoperative care. For this reason, preoperative labs serve as an important tool to optimize client care, enhance surgical safety, and minimize potential complications. Table 2.3b summarizes common preoperative lab work and its purpose. Refer to “Appendix A – Normal Reference Ranges” for a summary of common laboratory tests and their normal reference ranges.
Table 2.3b. Preoperative Lab Work[23]
| Lab Test | Purpose |
|---|---|
| Complete Blood Count (CBC) | Assesses overall health and detects anemia, infection, or abnormal platelet levels |
| Basic Metabolic Panel (BMP) | Evaluates kidney function, electrolyte levels, and glucose |
| Liver Function Tests (LFTs) | Assesses liver function and detects liver diseases |
| Coagulation Profile | Evaluates blood clotting ability |
| Blood Type and Rh Factor | Determines blood type compatibility for potential transfusions |
| Urinalysis | Screens for urinary tract infections and assesses kidney function |
| Chest X-ray | Assesses lung health and detects abnormalities |
| Electrocardiogram (ECG/EKG) | Evaluates heart’s electrical activity and detects abnormalities |
| Pregnancy Test | Determines pregnancy status (for females of childbearing age) |
| Other Specialized Tests | Depending on the client’s medical history and surgical procedure, additional tests such as serology, imaging (e.g., CT scan), or specific biomarkers may be requested |
Nursing Diagnoses
Nursing priorities for clients undergoing surgery are formulated based on the client’s preoperative history and assessment data and their specific needs related to the surgery. These nursing diagnoses guide the development of individualized care plans and nursing interventions.
Common nursing diagnoses related to preoperative care include the following:
- Risk for Injury
- Risk for Bleeding
- Risk for Delayed Surgical Recovery
- Anxiety
- Fear
- Readiness for Enhanced Knowledge
Review information about creating nursing diagnoses in the “Diagnosis” section of the “Nursing Process” chapter of Open RN Nursing Fundamentals, 2e.
Outcome Identification
Outcome identification includes setting short- and long-term goals and creating expected outcome statements customized for the client’s specific needs. Expected outcomes are statements of measurable action for the client within a specific time frame that are responsive to nursing interventions.
Sample expected outcomes for common nursing diagnoses related to preoperative care are as follows:
- The client will remain free from injury during the perioperative period.
- The client will verbalize three potential postoperative complications and related actions to prevent them from occurring.
- The client will report decreased feelings of anxiety regarding the upcoming procedure or surgery.
Planning Preoperative Interventions
Preoperative client planning involves careful consideration of various elements to ensure a smooth and safe surgical experience.[24],[25],[26]
- Informed Consent: While the responsibility of obtaining signed consent lies with the surgeon, nurses play a crucial role in the process by assisting in obtaining and witnessing the client’s signature as valid consent. Nurses can also contribute to client understanding by clarifying facts presented by the physician and dispelling any myths or misconceptions that the client or family may have about the surgery. Clients have the right to withdraw their consent before undergoing surgery, and health care providers must respect their decision in such cases. Consent should be an ongoing process, allowing clients to make informed choices about their health care.[27],[28] Review additional information about informed consent in the “Basic Concepts Related to Surgery” section.
- NPO (Nothing by Mouth): NPO status, which includes refraining from eating, drinking, and smoking, is crucial before surgery. It helps reduce the risk of aspiration during anesthesia by minimizing gastric secretions. Typically, clients are advised to avoid food for at least six to eight hours and clear liquids for two hours before the procedure. Adherence to NPO guidelines is stressed, as failure to comply can result in surgery cancellation to prevent complications during anesthesia.
- Intestinal Preparation (Bowel Prep): In some surgical procedures, such as those involving the colon, intestinal preparation may be necessary. This is often referred to as “bowel prep.” Preparation involves the use of laxatives or enemas to cleanse the intestines, reducing the number of bacteria and preventing injury to the colon during surgery.
- Administration of Regularly Scheduled Medications: Clients who regularly take prescription and over-the-counter medications should consult with their medical physician and anesthesia provider to determine whether they should continue taking their medications before surgery. Depending on the medication, the indication for the use of the medication, and the surgery being performed, dosing may be adjusted or temporarily withheld to minimize potential complications. See Table 2.3c for a list of medications that are commonly withheld (or have adjusted dosages) prior to surgical procedures.
Table 2.3c. Medications Commonly Withheld or Have Dosage Adjustment Prior to Surgery[29],[30]
| Medication Class | Examples | Rationale |
|---|---|---|
| ACE Inhibitors | Captopril, Lisinopril | Increase the risk of hypotension during surgery. |
| Angiotensin Receptor Blockers | Losartan, Valsartan | Increase the risk of hypotension during surgery. |
| Antacids (non-soluble) | Mylanta, Tums | May increase the risk of aspiration during surgery. |
| Anticoagulants | Coumadin, Eliquis | Can increase risk of bleeding during surgery. It is important to determine why the client is taking an anticoagulant, and the provider weighs the risks versus benefits. |
| Antihyperlipidemic Agents (non-statins) | Zetia, Fenofibrate | Can increase the risk of bowel obstruction and rhabdomyolysis. |
| Antiplatelets | Aspirin, Plavix | Can increase risk of bleeding during surgery. It is important to determine why the client is taking an antiplatelet, and the provider weighs the risks versus benefits. |
| Diuretics | Furosemide, Hydrochlorothiazide | Increase the risk of hypokalemia, as well as low blood pressure. Diuretics may be continued if the client is taking them for heart failure (as opposed to hypertension). |
| Herbal Supplements | Chamomile, Ginkgo Biloba | Can increase risk of bleeding and/or interfere with anesthesia. |
| Insulin: Intermediate and Long-Acting | NPH, Lantus | Not held, but dose is generally decreased by 50% on day of surgery to prevent hypoglycemia. |
| Insulin: Rapid- and Short-Acting | Lispro, Regular | Can increase the risk of hypoglycemia. |
| Oral Antidiabetics | Glyburide, Metformin | Can increase the risk of hypoglycemia. |
| NSAIDs | Ibuprofen, Naproxen | Can increase risk of bleeding during surgery. |
| Triptans | Sumatriptan, Rizatriptan | When taken in conjunction with other common preoperative medications (such as Zofran), serotonin syndrome can occur. |
Interventions
Nurses perform many interventions during the perioperative period. Common interventions are described in the following subsections.
Collaborate With the Interprofessional Team to Prepare the Client for Surgery
As previously discussed, nurses are responsible for conducting preoperative assessments, gathering client history, and performing physical examinations to identify any potential risks or complications. Based on the assessment findings, nurses collaborate with the health care team to ensure the client is in optimal condition for the procedure. They collaborate and communicate effectively to ensure a smooth transition from the preoperative period to the operating room.
Provide Emotional Support
Nurses provide emotional support and reassurance to clients and their families during the preoperative period. They address client fears, anxiety, and concerns by actively listening, showing empathy, and utilizing therapeutic communication techniques. Nurses create a supportive environment to alleviate anxiety, promote trust, and improve the overall surgical experience.
Perform Preoperative Preparations
Nurses ensure that all necessary preoperative preparations are completed. This involves arranging for diagnostic tests, preparing the surgical site, administering preoperative medications as ordered, and ensuring that the client is ready for transportation to the operating room. Nurses pay close attention to detail and adhere to infection control practices to maintain client safety.[31],[32],[33]
Proper skin preparation is vital in preventing surgical wound infections by eliminating or reducing the number of microorganisms on the skin. This generally entails cleansing the entire body with antiseptic wipes (i.e., chlorhexidine wipes) prior to surgery. Some providers may also require clients to shower with antiseptic soap preoperatively. After the skin is cleansed, bed linens are to be changed, and the client is placed in a clean gown.
Nurses typically complete standardized documentation referred to as a “Preoperative Checklist” when preparing a client for surgery. See an example of a preoperative checklist in the following box.
See an example of a Preoperative/Pre Procedure Checklist.
Document and Implement Other Safety Measures
Nurses are responsible for accurate documentation in the preoperative period. They document all assessments, interventions, and client responses according to established protocols and guidelines. Nurses also implement safety measures, such as verifying client identification, confirming surgical site markings, and conducting time-outs to prevent wrong-site surgeries.[34],[35],[36]
Provide Health Teaching About Postoperative Procedures
Nurses teach clients about the surgical process and what to expect. They explain the procedure, address any concerns or questions, and provide instructions on preoperative preparations such as fasting, medication restrictions, and hygiene practices. Nurses ensure that clients understand the importance of following these instructions for a safe and successful surgery.
Clients may have various tubes, drains, or vascular access devices inserted before, during, and after surgery. Examples include nasogastric (NG) tubes for gastric decompression, intravenous (IV) access for administering fluids and medications, and surgical drains to remove excess fluids. Providing education about the purpose of these devices, their expected duration, and any necessary care or monitoring can help alleviate client anxiety and improve understanding.
Health teaching about anticipated postoperative care plays a vital role in promoting optimal recovery and preventing complications following surgical procedures. By providing comprehensive and tailored education, health care professionals empower clients to actively participate in their own care, minimize complications, and support a smooth recovery process. See Table 2.3d for information regarding common topics for health teaching related to surgery.[37],[38],[39],[40]
Table 2.3d. Health Teaching About Postoperative Procedures[41],[42],[43],[44]
| Postoperative Procedures | Description |
|---|---|
| Prevention of Respiratory Complications | |
| Breathing Exercises and Incentive Spirometry (IS) | Explain and demonstrate deep breathing exercises and incentive spirometry to promote lung expansion, improve oxygenation, and prevent atelectasis. View a video on IS using the information in the box below this table. |
| Coughing and Splinting | Explain and demonstrate techniques to effectively cough and splint incision site for clearing airway secretions. |
| Prevention of Cardiovascular Complications | |
| Anti-Embolism Stockings (TED Hose) | Explain the use of compression stockings to prevent venous stasis and Deep Vein Thrombosis (DVT). Teach signs of deep vein thrombosis to report to the health care provider, such as calf pain, unilateral swelling, and/or redness. |
| Sequential Compression Devices (SCD) | Explain devices providing intermittent compression to prevent venous stasis and DVT. Teach the signs of DVT. |
| Leg Exercises and Mobility | Encourage leg exercises and early mobilization to enhance blood flow and reduce cardiovascular complications, including DVT. |
| Infection Prevention | |
| Incision Care | Provide instructions on how to care for the surgical incision and how to keep it clean and dry. Teach signs of infection, dehiscence, and poor wound healing to report to the health care provider. |
| Hand Hygiene | Emphasize the importance of frequent handwashing or using hand sanitizer to prevent infection. |
| Antibiotics | Educate regarding the importance of completing the full course of postoperative antibiotics, if prescribed. |
| Avoiding Contamination | Provide guidance on avoiding unnecessary touching of the incision site and protecting it from contamination of potentially infectious substances. |
| Immunizations | Discuss the importance of staying up-to-date with recommended vaccinations. |
| Pain Control | |
| Medication Management | Provide detailed instructions on prescribed pain medications, dosage, and potential side effects. |
| Nonpharmacological Techniques | Explain nonpharmacological pain relief strategies. |
| Activity and Rest | Reinforce postoperative activity restrictions and promote safe mobility with assistive devices, as indicated. Provide guidance on balancing rest and gradually increasing activity levels. |
| Positioning and Support | Teach proper positioning techniques for enhanced comfort and pain reduction. |
| Pain Assessment | Educate clients on pain scales and encourage accurate communication of pain levels. |
| Prevention of Gastrointestinal and Genitourinary Complications | |
| Diet Advancement | Explain that it is common for bowel function to slow down or stop after surgery and the diet order will typically advance from clear liquids as bowel sounds return and the client passes flatus. |
| Prevention and Treatment of Constipation | Explain that constipation is common postoperatively and can be prevented and treated with early ambulation, increased fluids and a high-fiber foods as the diet is advanced postoperatively, and administration of prescribed stool softeners. Notify the health care provider if no bowel movement occurs within two or three days after surgery. |
| Prevention of Urinary Complications | Encourage fluids and monitor urine output and color. Notify the health care provider of low urine output or symptoms of urinary tract infection such as frequency, burning, or malodorous urine. |
View a supplementary YouTube video[45] on how to use an incentive spirometer: How to Use an Incentive Spirometer.
Administer Preoperative Medications
Preoperative medication administration is carefully tailored to the individual client based on various factors such as age, physical and psychological condition, medication history, height and weight, other medications being taken, and the specific surgical procedure. The selection of preoperative medications aims to address different aspects of the client’s needs and optimize their surgical experience.[46] Be sure that informed consent has been signed before administering any medications that may alter thinking processes. Table 2.3e summarizes common preoperative medications.
Table 2.3e. Common Preoperative Medications[47],[48],[49]
| Pre-Medication | Medications | Rationale |
|---|---|---|
| Anxiolytics | Diazepam (Valium) | Reduces anxiety and promotes a state of relaxation and calmness before surgery |
| Sedatives/Hypnotics | Midazolam (Versed) | Induces relaxation, alleviates preoperative stress, and creates a more comfortable environment for the client |
| Anticholinergics | Atropine | Reduces nasal and oral secretions, maintaining a clear airway during surgery |
| Anticholinergics | Glycopyrrolate | Prevents laryngospasm by blocking the effects of the parasympathetic nervous system, ensuring a patent airway |
| Vagal Blockers | Atropine | Decrease vagal-induced bradycardia, which can cause a slowing of the heart rate due to stimulation of the vagus nerve |
| Antiemetics | Ondansetron | Prevents postoperative nausea and vomiting |
| Induction Agents | Propofol | Decreases the amount of anesthetic required for the induction and maintenance of anesthesia, ensuring more stable anesthesia and outcomes |
| Antibiotics | Cefazolin (Ancef) | Prevents surgical site infections by administering prophylactic antibiotics approximately 60 minutes before the incision is made |
To reduce anxiety, anxiolytics may be administered to help calm and relax the client.[50] Sedatives or hypnotics may also be used to promote relaxation and alleviate any preoperative stress or apprehension. These medications help create a more comfortable environment for the client and facilitate a smoother transition into the operating room.
Anticholinergics may be given to reduce nasal and oral secretions, which can help maintain a clear airway during surgery. Additionally, anticholinergics can help prevent laryngospasm, a condition where the vocal cords spasm and cause difficulty in breathing. By blocking the effects of the parasympathetic nervous system, anticholinergics minimize secretions and help maintain a patent airway.[51],[52]
Another important consideration is the use of medications to address specific physiological responses. These medications can reduce vagal-induced bradycardia, which is a slowing of the heart rate caused by stimulation of the vagus nerve. Additionally, H2 blockers may be administered to inhibit gastric secretion, reducing the risk of aspiration and other gastrointestinal complications during surgery.[53],[54]
In some cases, preoperative medications can help decrease the amount of anesthetic needed for the induction and maintenance of anesthesia. This can lead to more stable anesthesia and improved client outcomes.[55],[56]
Lastly, administration of antibiotics is a crucial step in preventing surgical site infections. Antibiotics are typically given approximately 60 minutes prior to the incision to ensure adequate levels are present in the client’s system to combat any potential bacteria introduced during the surgical procedure.[57],[58]
Overall, the selection and administration of preoperative medications are carefully determined based on individual client needs, aiming to optimize client comfort, safety, and surgical outcomes. It is important for health care professionals to closely assess each client and consider their unique circumstances when determining the appropriate preoperative medication regimen.[59],[60]
Evaluation and Perform Final Checks Prior to Surgery
Evaluation focuses on the effectiveness of the nursing interventions by reviewing the client’s expected outcomes to determine if they were met by the time frames indicated. During the evaluation phase, nurses use critical thinking to analyze reassessment data and determine if a client’s expected outcomes have been met, partially met, or not met by the time frames established. If outcomes are not met or only partially met by the time frame indicated, the care plan should be revised. Reassessment should occur every time the nurse interacts with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with others on the interprofessional team.
The nurse plays a crucial role in ensuring that the client’s chart preparation is finalized before surgery to facilitate a smooth and safe surgical experience. It is the nurse’s responsibility to meticulously review the client’s chart, ensuring that all documentation, preoperative procedures, and orders are complete and up-to-date. This includes verifying that the surgical consent form and other relevant documents are properly filled out and signed by the client. Additionally, the nurse should carefully document and promptly report any abnormal test results or findings that may impact the client’s surgical course. By effectively communicating special needs and concerns to the surgical team, the nurse contributes to a comprehensive understanding of the client’s condition and ensures that appropriate interventions and accommodations are in place. Through their attention to detail and proactive approach, nurses play a crucial role in ensuring that the client’s chart is thoroughly prepared, minimizing potential risks and maximizing the overall quality of care during the surgical process.
Prior to surgery, it is essential to finalize the preparation of the client to ensure a safe and efficient surgical experience. The nurse plays a key role in this process by ensuring that the client is appropriately dressed in a hospital gown, which allows for easy access to the surgical site while maintaining their privacy. To prevent loss or damage, the nurse ensures that no valuables are on the client and advises them to tape their rings in place if they cannot be removed. All pierced jewelry is removed to minimize the risk of injury during surgery. The nurse confirms that the client’s identification (ID) and allergy bands are securely fastened to ensure accurate client identification and prevent adverse reactions. Dentures are removed, as well as glasses/contacts and hearing aids. Additionally, the nurse instructs the client to empty their bladder before the surgery to promote comfort and prevent potential complications during the procedure.
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- Smetana, G. W. (2022). Preoperative medical evaluations of the healthy adult patient. UpToDate. https://www.wolterskluwer.com/en/solutions/uptodate ↵
- Smetana, G. W. (2022). Preoperative medical evaluations of the healthy adult patient. UpToDate. https://www.wolterskluwer.com/en/solutions/uptodate ↵
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Begins when the client is scheduled for surgery and ends at the time of transfer to the surgical suite.
Members of the healthcare team who work with children and their families to provide education and preparation during hospitalization.
Statements of measurable action for the client within a specific time frame that are responsive to nursing interventions
Collapse of lung tissue.
The formation of a blood clot in a deep vein within the body.