1. Prepared By Miss Fatima Hirzallah

2.  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.

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

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

6.  Emergent: require immediate attention without delay.  Urgent: require prompt attention within 24-30 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

7.  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.

8.  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.

9. 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.

10.  Leave all jewelry, money and valuables at home.  Do not wear makeup, perfume  Complete preliminary admission procedures with the Outpatient Admitting Department.  Wear a sweat suit or comfortable, loose clothing.  Do not eat or drink anything after midnight. If you are taking prescription medications, you will receive special instructions

11.  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

12. 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

13.  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.

14.  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