General Preoperative Nursing Interventions

GENERAL PREOPERATIVE NURSING INTERVENTIONS

Managing Nutrition and Fluids

The major purpose of withholding food and fluid before surgery is to prevent aspiration. However, studies demonstrate that in pa-tients who do not have a compromised airway or coexisting dis-eases or disorders that affect gastric emptying or fluid volume (eg, pregnancy, obesity, diabetes, gastroesophageal reflux, enteral tube feeding, ileus or bowel obstruction), lengthy restriction of fluid and food is unnecessary (Crenshaw & Winslow, 2002; Pandit, Loberg & Pandit, 2000). Until recently, fluid and food were restricted preoperatively overnight and often longer. How-ever, recent review of this practice by the American Society of Anesthesiologists has resulted in new recommendations for per-sons undergoing elective surgery who are otherwise healthy (ASA Task Force on Preoperative Fasting, 1999). The recommendations depend on the age of the patient and type of food eaten. For example, adults are advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products (Crenshaw, Winslow & Jacobson, 1999; Crenshaw & Winslow, 2002). Most patients are currently allowed clear liquids up to 2 hours before an elective pro-cedure (Crenshaw & Winslow, 2002).

Preparing the Bowel for Surgery

Enemas are not commonly ordered preoperatively unless the pa-tient is undergoing abdominal or pelvic surgery. In this case, a cleansing enema or laxative may be prescribed the evening before surgery and may be repeated the morning of surgery. The goals of this preparation are to allow satisfactory visualization of the sur-gical site and to prevent trauma to the intestine or contamination of the peritoneum by feces. Unless the condition of the patient presents some contraindication, the toilet or bedside commode, rather than the bedpan, is used for evacuating the enema if the pa-tient is hospitalized during this time. Additionally, antibiotics may be prescribed to reduce intestinal flora.

Preparing the Skin

The goal of preoperative skin preparation is to decrease bacteria without injuring the skin. If the surgery is not performed as an emergency, the patient may be instructed to use a soap contain-ing a detergent-germicide to cleanse the skin area for several days before surgery to reduce the number of skin organisms; this prepa-ration may be carried out at home.

Generally, hair is not removed preoperatively unless the hair at or around the incision site is likely to interfere with the opera-tion. If hair must be removed, electric clippers are used for safe hair removal immediately before the operation.