NURSING PROCESS: CARE OF THE PATIENT IN THE PREOPERATIVE PERIOD
Preoperative
assessment of the surgical patient involves evaluat-ing the elements addressed
in the previous section on the factors that affect the patient undergoing
surgery. A variety of patient problems or nursing diagnoses can be anticipated
or identified on the basis of the assessment data.
During
the preoperative phase of care, nursing assessment usu-ally addresses the
following parameters:
·
Physical condition, including
respiratory, cardiac, and other major body systems as discussed earlier
·
Results of blood tests, x-ray
studies, and other diagnostic tests
·
Nutritional and fluid status
·
Medication use, as previously
described
·
Psychological preparedness for
surgery (anxiety, fear, spiri-tual and cultural beliefs)
·
Special considerations, including
the ambulatory surgery patient, gerontologic considerations, obesity, the
patient with a disability, or the patient undergoing emergency surgery, as
discussed earlier
Based
on the assessment data, major preoperative nursing diag-noses of the surgical
patient may include the following:
·
Anxiety related to the surgical experience
(anesthesia, pain) and the outcome of surgery
·
Fear related to perceived threat of
the surgical procedure and separation from support system
·
Knowledge deficit of preoperative
procedures and protocols and postoperative expectations
Failure
to identify and communicate pertinent preoperative risk factors may lead to
complications.
The
major goals for the preoperative surgical patient may include relief of
preoperative anxiety, decreased fear, increased knowledge of perioperative
expectations, and absence of preoperative com-plications.
Specific
nursing interventions are discussed in detail under psycho-social interventions
and preoperative teaching in the previous sections.
Nursing
management is discussed under psychosocial interven-tions in the previous
section.
Specific
nursing interventions pertaining to preoperative patient education are
discussed in detail in earlier sections.
Nursing
interventions to prevent preoperative complications include identification and
documentation of factors that affect patients preparing to undergo surgery.
Expected
patient outcomes may include:
1.
Reports relief of anxiety
a.
Discusses with anesthesiologist or
anesthetist concerns related to types of anesthesia and induction
b.
Verbalizes an understanding of the
preanesthetic med-ication and general anesthesia
c.
Discusses last-minute concerns with
nurse or physician
d.
Discusses financial concerns with
social worker, when appropriate
e.
Requests visit with member of clergy
when appropriate
f.
Relaxes quietly after being visited
by health care team members
2.
Reports that fear is decreased
a.
Discusses fears with health care
professionals
b.
Verbalizes an understanding of the
location of family members or significant others during procedure
3.
Voices understanding of surgical
intervention
a.
Participates in preoperative
preparation
b.
Demonstrates and describes exercises
he or she is ex-pected to perform postoperatively
c.
Reviews information about
postoperative care
d.
Accepts preanesthetic medication, if
prescribed
e.
Remains in bed once premedicated
f.
Relaxes during transportation to
operating room or unit
g.
States rationale for use of side
rails
h.
Discusses postoperative expectations
4. Shows
no evidence of preoperative complications.
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