Pre-operative Care

Nurse Ricci is feeling a bit anxious. She has been working as a staff nurse at the hospital’s Private Rooms department for weeks already. In fact, in all those weeks she has learned a lot and is striving to learn more. However, despite all those weeks working, she still hasn’t encountered some cases and for the first time, one of her patients is scheduled to have an operation today.

She paces around the station. What will she do? What will she prepare? Are there standard operating procedures she needs to follow? And if there are, how will she do it? She thinks to herself as she reaches for the hospital handbook containing all the hospital policies and SOPs.

Having to perform a certain procedure and/or having to handle a certain case for the first time may not be the most appealing to do for nurses who are newbies in the field. It may bring about a wave of anxiety and nervousness to the part of the nurse who is not yet very much experienced. For them, it may seem like a frightening experience and may want to do the best that they can to avoid encountering such like preparing a patient for the OR for the first time. Below are some of the most common pre-operative procedures/care that may guide and help ease the apprehension of nurses when the time comes.

Pre-operative care

Preoperative care refers to the preparation and management of a patient prior to surgery, which includes both physical and psychological preparation. No matter what surgery is to be performed to a patient, either minimally invasive or a major operation, pre-operative care is a must. With preoperative care, physical and psychological preparations, comes better outcomes post operatively.

Preoperative care may be done for weeks before the procedure on an outpatient basis, or a day before the operation in admitted patients.

Physical Preparation

Usually, for a patient’s physical preparation, certain tests and background tests are conducted. It may include obtaining a complete medical history and physical exam, including the patient’s surgical and anesthesia background if he is allergic to anesthesia, or has any adverse reactions to it like anaphylactic shock. The patient must also inform the health team if he there is history in his family of malignant hyperthermia.

• As for the laboratory exams, it may include conducting a Complete Blood Count (CBC) test, electrolytes, prothrombin time, activated partial thromboplastin time, and urinalysis.
• As for patients with a history of heart disease and/or is above 50 years of age, an electrocardiogram may be done to view his tracings and electrical activity of the heart.
• For patients with a history of a respiratory disease may be ordered to have a Chest Xray done.
• Nutritional deficiencies, steroid use, radiation or chemotherapy, drug or alcohol abuse, or metabolic diseases such as diabetes are also checked since they are factors that may impair the healing process.
• A list of medications, herbal supplements and vitamins that the patient is taking must also be obtained and noted since they may interact and create adverse effects with certain anesthetics.
• An allergy with latex must also be noted as latex is found in materials needed for the surgery such as most sterile gloves, medical supplies like general anesthesia masks, tubings, and muti-dose vials. With this knowledge, latex-free gloves and supplies will be used during the procedure.
• For patients who will be undergoing a surgery of the lower gastrointestinal tract may be ordered to undergo bowel clearance which will be done early the evening before the surgery. This is to prevent interrupted sleep during the night.
• Skin preparation may also be ordered the night before the surgery, which involves scrubbing with a special soap, hair removal of the surgical area. However, shaving hair is at present no longer recommended as it may irritate the sight and increase the chance of infection. Adhesive barrier drapes may be used as they can contain hair growth on the skin around the incision.

Psychological preparation

Encountering a major event like an operation may bring about stress and anxiety on the part of the patients. With these in mind, it is important to pay attention not only to the physical aspect of care and preparation, but also to prepare the patient and family (as well) psychologically.

• Pastoral care may be available in some hospitals and institutions.
• When the patient verbalizes his concerns and issues regarding the procedure especially the fear of dying, it is important to inform the physician. In some cases, surgery may be postponed until the patient feels comfortable.
• For pediatric patients, a parent may be allowed with them if possible. But only if the parent is not as apprehensive as and shows fear to the pediatric patient. A fearful parent may only contribute to added apprehension on the child’s part.
• Preoperative teaching must be done including instructions about the preoperative period, the surgery itself, and the postoperative period. Usually it involves the expected arrival time (for outpatients), where they should go for surgery and how long they should be on NPO. They may also be instructed with certain medications to be taken prior to surgery.
• The patient will be informed what will be done during the surgery, where the incision will be and how the long the procedure is going to take. These are usually done by the physician. Expected outcomes may be discussed as well such as coughing and deep breathing exercises

Other concerns

A procedure like operations and surgeries warrant an informed consent. It is one of the most important things to seek prior to the surgery, legally. It is the physician’s responsibility to explain the procedure to the patient and folks as well as the risks and possible outcomes and complications. Other treatment options may also be discussed. The nurse, on the other hand, acts as the witness to the patient’s signature on the consent form.

Understanding of the procedure is important and in most cases, the patient is asked to explain what they were told in order for the nurse and/or health care member to determine how much the patient has understood.

As for patients who are minor, mentally impaired, heavily sedated or critically ill who are not considered legally able to give consent, the next of kin may act as surrogate and sign the form. He/she may be the spouse, adult sibling, adult child, parent or guardian, or any person with medical power of attorney.

Sources:

• http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html#ixzz2rg7UB36d
• http://www.ejgh.org/index.php?option=com_content&view=article&id=451&Itemid=430

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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