Pre -operative Nursing Management Prepared By Miss Fatima Hirzallah

The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the pt into the operating room table.

preoperative interview (which include physical, emotional assessment, previous anesthetic history, allergies or genetic problems, ensure that Necessary tests performed, Arranging appropriate consultative services.

Surgical classifications 1.Diagnostic ( biopsy) 2.Curative ( excision of tumor) 3.Reparative (multiple wound repair) 4.Reconstructive or cosmetic ( mamoplasty) 5.Palliative (relief pain or correct a problem)

According to degree of urgency Emergent: require immediate attention without delay. Urgent: require prompt attention within hours. Required: requires operation, plan hospital admission within a few wks or months. Elective: should be operated on, failure to have surgery isn’t catastrophic. Optional: the decision rests with the pt, depend on personal preference

The patient’s major goals are: Correction or treatment of physical problem Relief of anxiety, worry and depression Acceptance of and preparation for surgical interventions Acceptance and tolerance of preansthetic medications and agents. Avoidance of injury, Nosocomial infections, and complications.

The major nursing goals are to: Assist the pt in understanding the physical and psychosocial aspects of the surgical experience Acquaint the pt and his family with the environment, protocol, and expectations as surgery. Teach the pt certain procedures that will help in reducing post operative complications Prepare the physically and psychologically for the operation Collaborative with other members of the health team in coordinating all preoperative procedures.

The major nursing goals are to: Assist the pt in understanding the physical and psychosocial aspects of the surgical experience Acquaint the pt and his family with the environment, protocol, and expectations as surgery. Teach the pt certain procedures that will help in reducing post operative complications Prepare the physically and psychologically for the operation Collaborative with other members of the health team in coordinating all preoperative procedures.

Preparation for surgery 1-Informed Consent Criteria for valid Informed consent: Voluntary consent Incompetent pt ( mentally retarded, mentally ill, or comatose) Informed subject Explanation Description of risks and benefits Answer questions about procedure Instructions Pt able to comprehend. (Information written in understandable language.

Assessment of health factors that affect pts preoperatively  Assessment of Nutritional and fluid status.  Respiratory status  Cardiovascular status  Assessment of hepatic and renal function  Assessment of endocrine function  Assessment of immunological function  Assessment of effects of aging  Assessment of prior drug therapy  Assessment pts with disabilities

Preoperative Nursing Interventions The two goals of preoperative care are:  To present the pt in the best possible physical and psychosocial conditions for his operation  To initiate every effort that will eliminate or reduce post operative discomforts and complications. Nutrition and fluids: Intestinal preparation Preoperative skin preparation

Preoperative Teaching The goal of preoperative teaching is to familiarize the pt with the expected post operative outcomes such as: Facilitation of recuperative period. Attainment of a sense of well-being with minimal fear of the unknown. Decreased need for analgesics Absence of complications Decrease time for hospitalization

 When and What to teach: Teaching sessions are combined with various preparations to allow for an easy and timely flow of information and allow time for questions. Teaching should include description of the procedures and include explanations of sensations of the pt’s will experience. The ideal timing or preoperative teaching isn’t on the day of operation, but during the preadmission visit when diagnostic tests are performed.

 Deep breathing and coughing: Teaching the pt how to promote optimal lung expansion and consequent bloody oxygenation after anesthesia. The goal in promoting coughing is to mobilize secretions so they can be removed.If the pt doesn’t cough effectively, Atelectasis (lung collapse), pneumonia, and other lung complications may occur.

 Deep breathing and coughing: Teaching the pt how to promote optimal lung expansion and consequent bloody oxygenation after anesthesia. The goal in promoting coughing is to mobilize secretions so they can be removed.If the pt doesn’t cough effectively, Atelectasis (lung collapse), pneumonia, and other lung complications may occur.

 Pain Control and Management: Post operatively, medications are administered to relief pain and maintain comfort without increasing the risks for inadequate air exchange.  Cognitive Coping Strategies: Cognitive strategies may be useful for relieving tension, overcoming anxiety,, Imagery: the pt can concentrates on a pleasant experience  Distraction: thinks of an enjoyable story or song

Preoperative psychosocial interventions  Reducing preoperative anxiety Cognitive strategies useful for reducing anxiety, music therapy is an easy to administer, inexpensive, noninvasive intervention  Decreasing Fears  Reflecting Cultural, Spiritual, and Religious Beliefs Include identifying and showing respect for cultural, spiritual, and religious beliefs, such as in pain control, or in blood transfusion.

Preoperative psychosocial interventions  Reducing preoperative anxiety Cognitive strategies useful for reducing anxiety, music therapy is an easy to administer, inexpensive, noninvasive intervention  Decreasing Fears  Reflecting Cultural, Spiritual, and Religious Beliefs Include identifying and showing respect for cultural, spiritual, and religious beliefs, such as in pain control