Chapter 16

Care of Preoperative Patients

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Preoperative Period

Begins when patient is scheduled for surgery;

ends at time of transfer to surgical suite
Nurse functions as educator, advocate,
promoter of health and safety

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Patient & Family Teaching

Tubes
Drains
Vascular access

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Nasogastric Tube

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Prevention of Respiratory
Complications

Breathing exercises
Incentive spirometry
Coughing and splinting

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Older Adults: Changes of Aging

as Surgical Risk Factors

Decreased:

Cardiac output, peripheral circulation

Vital capacity, blood oxygenation
Blood flow to kidneys, glomerular filtration rate

Increased:

Blood pressure
Risk for skin damage, infection
Sensory deficits
Deformities related to osteoporosis/arthritis

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Older Adults: Considerations for

Preoperative Care

Chronic illness
Malnutrition
Impaired self-care ability
Allergies
Inadequate support systems

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Older Adults: Considerations for

Preoperative Care (contd)

Stress from surgery/anesthesia

Cardiopulmonary complications after surgery
Mental status changes
Risk for falls

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Reasons for Surgery

Diagnostic determines origin and cause of

disorder
Curative resolves health problem by
repairing or removing cause
Restorative improves patients functional
ability
Palliative relieves symptoms of disease
process, but does not cure
Cosmetic alters/enhances personal
appearance
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Urgency and Degree of Risk of

Surgery

Urgency:

Elective
Urgent
Emergent

Degree of Risk:

Minor
Major

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Extent of Surgery

Simple
Radical
Minimally invasive (MIS)

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Anxiety Interventions

Preoperative teaching
Encourage communication
Promote rest
Use distraction
Teach family members

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Skin Preparation

Break in the skin increases risk for infection

Patient may be asked to shower using
antiseptic solution
Hair removal by electric clippers, depilatories
Shaving of hair creates risk for infection!

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Preoperative Drugs

Reduce anxiety
Promote relaxation
Reduce nasal and oral secretions

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Preoperative Drugs (contd)

Prevent laryngospasm
Reduce vagal-induced bradycardia
Inhibit gastric secretion
Decrease amount of anesthetic needed for
induction and maintenance of anesthesia

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Collaborative Management:
Assessment

History and data collection:

Age
Drugs, substance use
Medical history (including cardiac and pulmonary)
Complementary/alternative practices
Previous surgical procedures, anesthesia
Blood donations
Discharge planning

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Physical Assessment/Clinical
Manifestations

Obtain baseline vital signs

Focus on problem areas identified in history;
all body systems affected by surgical
procedure
Report abnormal assessment findings to
surgeon/anesthesiology personnel

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System Assessment

Cardiovascular

Respiratory

CAD, MI within 6 months before surgery, angina,

hypertension, dysrhythmias
Chronic respiratory problems
Smoking increases carboxyhemoglobin blood
level, deceases oxygen delivery

Renal/Urinary

Kidney impairment inhibits drugs/anesthetic agent

excretion

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System Assessment (contd)

Neurologic

Musculoskeletal
Nutritional status

Determine baseline
Assess LOC, ability to follow commands

Malnutrition and obesity increase surgical risk

Psychosocial

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Prevention of Cardiovascular
Complications

Be aware of patients at greater risk for DVT

Antiembolism stockings
Pneumatic compression devices
Leg exercises
Mobility

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Laboratory Assessment

Urinalysis
Blood type and crossmatch
CBC or hemoglobin level and hematocrit
Clotting studies (PT, INR, aPTT)

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Laboratory Assessment (contd)

Electrolyte levels
Serum creatinine level
Pregnancy test
Chest x-ray
ECG

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Insufficient Information Interventions

Preoperative teaching
Informed consent:

Surgeon obtains signed consent before sedation

and/or surgery
Nurse clarifies facts and dispels myths about
surgery
Nurse not responsible for providing detailed
information about procedure!

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Informed Consent

Patients may sign with X

In emergency, telephone authorization is
acceptable
Special permits required for some procedures

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NPSGs and Informed Consent

Ensure correct site is selected and wrong site

is avoided
Licensed independent practitioner marks site,
involving patient if possible
Time out procedure adopted by most
facilities

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Implementing Dietary Restrictions

NPO: Patient not to ingest anything by mouth

for 6 to 8 hours before surgery:

Decreases risk for aspiration

Give patients written/oral directions to stress
adherence
Surgery can be canceled if instructions not
followed

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Administering Regularly Scheduled

Medications

Consult with physician and anesthesia

provider for instructions
Drugs for certain conditions often allowed
with a sip of water:

Cardiac disease
Respiratory disease
Seizures
Hypertension

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Intestinal Preparation

Performed to prevent injury to colon; reduce

number of intestinal bacteria
Enema or laxative

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Patient Using Incentive Spirometer

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Patients at Risk for VTE

Obese patients
Age 40 or older
History of cancer
Decreased mobility or immobile
Spinal cord injury

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Patients at Risk for VTE (contd)

History of VTE, PE, varicose veins, edema

Oral contraceptives
Smoking
History of decreased cardiac output
Hip fracture, total hip/knee surgery

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External Pneumatic Compression

Devices

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Preoperative Chart Review

Ensure all documentation, preoperative

procedures, orders are complete
Check surgical consent form and others for
completeness
Inform patient that area will be marked before
procedure begins
Document allergies, height, and weight

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Preoperative Chart Review (contd)

Ensure all laboratory and diagnostic test

results are in chart
Document/report any abnormal results
Report special needs and concerns

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Preoperative Patient Preparation

Remove most clothing; provide gown

Leave valuables with family member or lock
up
Tape rings in place if cannot be removed
Ensure patient is wearing ID band

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Preoperative Patient Preparation

(contd)

Remove:

Dentures
Prosthetic devices
Hearing aids
Contact lenses
Fingernail polish
Artificial nails
Pierced jewelry

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Drugs for Preoperative Preparation

Sedatives
Hypnotics
Anxiolytics
Opioid analgesics
Anticholinergic agents
H2 histamine blockers

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Chapter 16

Audience Response System Questions

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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.

Providing a recent patient history, vital signs, allergy, and

medication updates
Verbally verifying that the operating room nurse understands
the report
Encouraging the operating room nurse to interrupt to ask
questions as the perioperative nurse provides report
Using a standardized hand-off communication tool to provide
report (e.g., SBAR, Five-Ps, PACE)

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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.

Serum sodium level 149 mEq/L

Fasting blood glucose 120 mg/dL
Hemoglobin 10.5 g/dL
Serum potassium 2.9 mEq/L

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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

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