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Chapter: Medical Surgical Nursing: Preoperative Nursing Management

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Immediate Preoperative Nursing Interventions

The patient changes into a hospital gown that is left untied and open in the back.

IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS

 

The patient changes into a hospital gown that is left untied and open in the back. The patient with long hair may braid it, remove hair-pins, and cover the head completely with a disposable paper cap.

 

The mouth is inspected, and dentures or plates are removed. If left in the mouth, these items could easily fall to the back of the throat during induction of anesthesia and cause respiratory obstruction.

Jewelry is not worn to the operating room; wedding rings and jewelry of body piercings should be removed to prevent injury (Fogg, 2001). If a patient objects to removing a ring, some insti-tutions allow the ring to be securely fastened to the finger with tape. All articles of value, including assistive devices, dentures, glasses, and prosthetic devices, are given to family members or are labeled clearly with the patient’s name and stored in a safe place according to the institution’s policy.

 

All patients (except those with urologic disorders) should void immediately before going to the operating room to promote con-tinence during low abdominal surgery and to make abdominal organs more accessible. Urinary catheterization is performed in the operating room as necessary.

Administering Preanesthetic Medication

The use of preanesthetic medication is minimal with ambulatory or outpatient surgery. If prescribed, it is usually administered in the preoperative holding area. If a preanesthetic medication is administered, the patient is kept in bed with the side rails raised because the medication can cause lightheadedness or drowsiness. During this time, the nurse observes the patient for any untoward reaction to the medications. The immediate surroundings are kept quiet to promote relaxation.

Often, surgery is delayed or operating room schedules are changed, and it becomes impossible to request that a medica-tion be given at a specific time. In these situations, the pre-operative medication is prescribed “on call from operating room.” The nurse can have the medication ready to give and adminis-ter it as soon as a call is received from the operating room staff. It usually takes 15 to 20 minutes to prepare the patient for the operating room. If the nurse gives the medication before at-tending to the other details of preoperative preparation, the pa-tient will have at least partial benefit from the preoperative medication and will have a smoother anesthetic and operative course.

Maintaining the Preoperative Record

 

A preoperative checklist contains critical elements that need to be checked preoperatively (Meeker & Rothrock, 1999). An example is shown in Figure 18-3. The completed chart accompanies the pa-tient to the operating room with the surgical consent form attached, along with all laboratory reports and nurses’ records. Any unusual last-minute observations that may have a bearing on anesthesia or surgery are noted at the front of the chart in a prominent place.


Transporting the Patient to the Presurgical Area

The patient is transferred to the holding area or presurgical suite in a bed or on a stretcher about 30 to 60 minutes before the anesthetic is to be given. The stretcher should be as comfortable as possible, with a sufficient number of blankets to prevent chilling in air-conditioned rooms. A small head pillow is usu-ally provided.

 

The patient is taken to the preoperative holding area, greeted by name, and positioned comfortably on the stretcher or bed. The surrounding area should be kept quiet if the preoperative medication is to have maximal effect. Unpleasant sounds or con-versation should be avoided because a sedated patient who over-hears them might misinterpret them.

Patient safety in the preoperative area is a priority. Using a process to verify patient identification, the surgical procedure, and the surgical site maximizes patient safety and allows for early identification and intervention if any discrepancies are identified (Brown, Riippa & Shaneberger, 2001).

Attending to Family Needs

Most hospitals and ambulatory surgery centers have a waiting room where the family and significant others can wait while the patient is undergoing surgery. This room may be equipped with comfortable chairs, television, telephones, and facilities for light refreshment. Volunteers may remain with the family, offer them coffee, and keep them informed of the patient’s progress. After surgery, the surgeon may meet the family in the waiting room and discuss the outcome.

 

The family and significant others should never judge the seri-ousness of an operation by the length of time the patient is in the operating room. A patient may be in surgery much longer than the actual operating time for several reasons:

·        Patients are routinely transported well in advance of the ac-tual operating time.

 

·        The anesthesiologist or anesthetist often makes additional preparations that may take 30 to 60 minutes.

 

·         The surgeon may take longer than expected with the preced-ing case, which delays the start of the next surgical procedure.

 

After surgery, the patient is taken to the PACU to ensure safe emergence from anesthesia.

Family members and significant others waiting to see the pa-tient after surgery should be informed that the patient may have certain equipment or devices (eg, intravenous lines, indwelling urinary catheter, nasogastric tube, oxygen lines, monitoring equip-ment, and blood transfusion lines) in place when he or she returns from surgery. When the patient returns to the room, the nurse provides explanations regarding the frequent postoperative ob-servations that will be made. However, it is the responsibility of the surgeon, not the nurse, to relay the surgical findings and the prognosis, even when the findings are favorable.

 

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