PREOPERATIVE PATIENT NEEDS BY: MICHAEL FRIEDMAN CST

BIOPSYCHOSOCIAL NEEDS äphysical considerations äpsychological considerations äpsychosocial considerations

BIOPSYCHOSOCIAL NEEDS äphysical considerations –completion of activities on the preoperative checklist –skin preparation shavingshower/bath reduction of flora at the operative site

BIOPSYCHOSOCIAL NEEDS äphysical considerations –bowel preparation chemical - antibiotics mechanical - enema

BIOPSYCHOSOCIAL NEEDS äphysical considerations –NPO GOALS: –decreased gastric motility related to the stress of surgery –prevent aspiration of gastric contents age/condition appropriate –adults - greater than 8 hours –children - based on feeding schedule H2 antagonists/antacid

BIOPSYCHOSOCIAL NEEDS äphysical considerations –pre-operative medication Sedative/tranquilizerAnticholinergic –dry secretions –increase heart rate

BIOPSYCHOSOCIAL NEEDS äpsychological considerations –fear deathpainanesthesia mutilation/alterations in body image cancer

BIOPSYCHOSOCIAL NEEDS äpsychological considerations –fear external influences –job –money –finances –family

BIOPSYCHOSOCIAL NEEDS äpsychological considerations –dependence lack of knowledge –surroundings –personnel –procedures –special considerations/needs of children age-related issues

BIOPSYCHOSOCIAL NEEDS äpsychosocial considerations –support systems significant others –spiritual/religious needs visits by clergy or religious special objects prayer

THE PREOPERATIVE CHECKLIST

EDUCATION äthe OR experience äthe surgical intervention äorientation to personnel in other units äpatient’s psychosocial needs

PATIENT TEACHING äthe OR experience äthe PACU experience äIV therapy äFoley catheterization äpost-operative drainage systems ädressings äoxygen

PATIENT TEACHING äNPO status äpre-operative medications and their effects äpostoperative pain control äpostoperative exercises äpostoperative restrictions äICU/CCU

PHYSICAL PREPARATION OF THE PATIENT äskin preparation äbowel preparation äremoval of jewelry/nail polish

MEDICAL STAFF VISITS äsurgeon äanesthesia personnel äOR team

CHART DOCUMENTATION

ähistory and physical –written documentation of the patient’s preoperative conditions –each patient should have a completed history and physical done within the last two weeks or sooner, if indicated

CHART DOCUMENTATION ähistory and physical –information include: illness history social history allergies past medical history a review of the organ systems current physical examination

CHART DOCUMENTATION äconsultations –expert opinions from practitioners specializing in an area of medical care or rehabilitative services –the report should be on the patient’s chart prior to coming to the Operating Room

CHART DOCUMENTATION älaboratory testing –basic testing includes CBC and UA –may include other blood test, depending on the patient’s age, medical condition, and other medical diseases

CHART DOCUMENTATION älaboratory testing –CBC (complete blood count) counts the number of each type of cell in the blood includes: –RBC - red blood count - the number indicates the blood’s ability to carry oxygen –WBC - white blood count - the number indicates the presence/absence of systemic infection

CHART DOCUMENTATION älaboratory testing –CBC (complete blood count) counts the number of each type of cell in the blood includes: –H&H - Hemoglobin and Hematocrit - the number indicates the ability to carry oxygen and nutrients –Diff - differential - counts the specific types of white blood cells, indicating certain types of infections

CHART DOCUMENTATION älaboratory testing –UA gives information regarding the body’s metabolism and kidney function includes: –specific gravity - indicates how well the kidneys save water and concentrate urine, and the hydration state of the body –pH - indicates the acid/base balance of the body and the mechanisms that regulate acid removal from the body

CHART DOCUMENTATION älaboratory testing –UA gives information regarding the body’s metabolism and kidney function includes: –RBC/WBC - their abnormal presence indicates infection/bleeding within the Urinary System –protein/albumin - their abnormal presence indicates poor kidney filtration/function

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 tests serum chemical levels in the body, liver function, glucose metabolism and essential electrolytes in the body

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 includes: –BUN - blood urea nitrogen - general indicator of the kidney's ability to remove waste from the blood stream –Creatinine - a more specific indicator of kidney function

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 includes: –FBS - Fasting Blood Sugar - indicates the circulating level of sugar available for cell metabolism, and indirectly indicates the level of insulin available for glucose transportation into the cells

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 includes: –SGOT/SGPT - Serum Glutamic Oxaloacetic Transaminase and Serum Glutamic Pyruvic Transaminase / Liver Enzymes - indicate liver functioning and point to diseases such as hepatitis, gallbladder disease, liver damage, and cirrhosis

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 includes: –LYTES - Electrolytes - sodium, chlorides, potassium, and carbon dioxide - indicates correct levels of these essential chemicals in the blood which are necessary for normal cell function

CHART DOCUMENTATION älaboratory testing –Blood Chemistry or SMA-12 includes: –Cholesterol and Triglycerides - indicate the potential to form plaque within the cardiovascular system

CHART DOCUMENTATION älaboratory testing –PT/PTT prothrombin time and partial thromboplastin time indicates the blood’s ability to clot, indirectly indicating the potential to bleed

CHART DOCUMENTATION laboratory testing –Type and Screen/Type and Crossmatch identifying the factors in patient’s blood for potential matching with replacement blood units laboratory matching of the patient's blood to compatible units of replacement blood when a blood transfusion is necessary

CHART DOCUMENTATION laboratory testing –other thyroid screening (T3, T4, TSH) medication levels - digoxin, antibiotics, dilantin

CHART DOCUMENTATION chest x-ray –evaluates the lung’s ability to transfer oxygen, carbon dioxide and anesthetic gasses EKG –measurement of the heart’s electrical conduction to indicate cardiac muscle action and function

CHART DOCUMENTATION vital signs –body temperature –blood pressure –pulse –respirations

CHART DOCUMENTATION consent –valid consent - see notes

PATIENT CHECKLIST removal of prosthetics –dentures –artificial limbs –contact lenses/eyeglasses –hearing aides –wigs –rings/watches/jewelry

PATIENT CHECKLIST voiding pre-operative medications patient identification –identification bracelet –allergy bracelet

PREOPERATIVE CARE OF THE PATIENT