1. 1 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

2. 2  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

3. 3 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Tubes  Drains  Vascular access

4. 4 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

5. 5  Breathing exercises  Incentive spirometry  Coughing and splinting

6. 6 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

7. 7 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Chronic illness  Malnutrition  Impaired self-care ability  Allergies  Inadequate support systems

8. 8 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Stress from surgery/anesthesia  Cardiopulmonary complications after surgery  Mental status changes  Risk for falls

9. 9 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Diagnostic – determines origin and cause of disorder  Curative – resolves health problem by repairing or removing cause  Restorative – improves patient’s functional ability  Palliative – relieves symptoms of disease process, but does not cure  Cosmetic – alters/enhances personal appearance

10. 10 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Urgency:  Elective  Urgent  Emergent  Degree of Risk:  Minor  Major

11. 11 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Simple  Radical  Minimally invasive (MIS)

12. 12 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Preoperative teaching  Encourage communication  Promote rest  Use distraction  Teach family members

13. 13 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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!

14. 14 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Reduce anxiety  Promote relaxation  Reduce nasal and oral secretions

15. 15 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Prevent laryngospasm  Reduce vagal-induced bradycardia  Inhibit gastric secretion  Decrease amount of anesthetic needed for induction and maintenance of anesthesia

16. 16 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

17. 17 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

18. 18 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Cardiovascular  CAD, MI within 6 months before surgery, angina, hypertension, dysrhythmias  Respiratory  Chronic respiratory problems  Smoking increases carboxyhemoglobin blood level, deceases oxygen delivery  Renal/Urinary  Kidney impairment inhibits drugs/anesthetic agent excretion

19. 19 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Neurologic  Determine baseline  Assess LOC, ability to follow commands  Musculoskeletal  Nutritional status  Malnutrition and obesity increase surgical risk  Psychosocial

20. 20 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Be aware of patients at greater risk for DVT  Antiembolism stockings  Pneumatic compression devices  Leg exercises  Mobility

21. 21 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Urinalysis  Blood type and crossmatch  CBC or hemoglobin level and hematocrit  Clotting studies (PT, INR, aPTT)

22. 22 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Electrolyte levels  Serum creatinine level  Pregnancy test  Chest x-ray  ECG

23. 23 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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!

24. 24 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Patients may sign with “X”  In emergency, telephone authorization is acceptable  Special permits required for some procedures

25. 25 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

26. 26 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

27. 27 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

28. 28 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Performed to prevent injury to colon; reduce number of intestinal bacteria  Enema or laxative

29. 29 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

30. 30 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Obese patients  Age 40 or older  History of cancer  Decreased mobility or immobile  Spinal cord injury

31. 31 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  History of VTE, PE, varicose veins, edema  Oral contraceptives  Smoking  History of decreased cardiac output  Hip fracture, total hip/knee surgery

32. 32 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

33. 33 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

34. 34 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Ensure all laboratory and diagnostic test results are in chart  Document/report any abnormal results  Report special needs and concerns

35. 35 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  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

36. 36 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Remove:  Dentures  Prosthetic devices  Hearing aids  Contact lenses  Fingernail polish  Artificial nails  Pierced jewelry

37. 37 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Sedatives  Hypnotics  Anxiolytics  Opioid analgesics  Anticholinergic agents  H 2 histamine blockers

38. 38 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 38

39. 39 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 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. Providing a recent patient history, vital signs, allergy, and medication updates B. Verbally verifying that the operating room nurse understands the report C. Encouraging the operating room nurse to interrupt to ask questions as the perioperative nurse provides report D. Using a standardized hand-off communication tool to provide report (e.g., SBAR, Five-Ps, PACE)

40. 40 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 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. Serum sodium level 149 mEq/L B. Fasting blood glucose 120 mg/dL C. Hemoglobin 10.5 g/dL D. Serum potassium 2.9 mEq/L

41. 41 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 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. Shellfish B. Sulfa drugs C. Codeine D. Kiwi