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Chapter: Medical Surgical Nursing: Preoperative Nursing Management

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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.

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.

Assessment

 

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

 

Diagnosis

 

NURSING DIAGNOSES

 

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

 

COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS

Failure to identify and communicate pertinent preoperative risk factors may lead to complications.

Planning and Goals

 

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.

 

Nursing Interventions

 

REDUCING PREOPERATIVE ANXIETY

 

Specific nursing interventions are discussed in detail under psycho-social interventions and preoperative teaching in the previous sections.

 

DECREASING FEAR

 

Nursing management is discussed under psychosocial interven-tions in the previous section.

 

PROVIDING PATIENT EDUCATION

 

Specific nursing interventions pertaining to preoperative patient education are discussed in detail in earlier sections.

 

MONITORING AND MANAGING POTENTIAL COMPLICATIONS

Nursing interventions to prevent preoperative complications include identification and documentation of factors that affect patients preparing to undergo surgery.

Evaluation

 

EXPECTED PATIENT OUTCOMES

 

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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