Chapter 17 Unit I

Chapter 17
Preoperative
Nursing
Management
LD Spring 2014
Perioperative Nursing
Preoperative phase: period of time from
decision for surgery until patient is transferred

into operating room
Intraoperative phase: period of time from
when patient is transferred into operating
room to admission to postanesthesia care unit
(PACU)
Postoperative phase: period of time from
when patient is admitted to PACU to follow-up
evaluation in clinical setting or at home
LD Spring 2014
Question
Tell whether the following statement is true or
false:
Intraoperative phase: the period of time from
the decision for surgery until the patient is
transferred into the operating room.
LD Spring 2014
Answer
False.
Rationale: The preoperative phase is the
period of time from the decision for surgery

until the patient is transferred into the
operating room. The intraoperative phase is
the period of time from when the patient is
transferred to the operating room to the
admission to postanesthesia care unit (PACU).
LD Spring 2014
Preadmission Testing
Initiates initial preoperative assessment
Initiates teaching appropriate to patients needs
Involves family in interview
Verifies completion of preoperative diagnostic
testing
Verifies understanding of surgeon-specific
preoperative orders
Discusses, reviews advanced-directive document
Begins discharge planning by assessing patients
need for postoperative transportation, care
LD Spring 2014
Special Considerations
During
Preoperative
Period
Gerontologic considerations
Patients who are obese
Patients with disabilities
Patients undergoing ambulatory surgery
Patients undergoing emergency surgery
LD Spring 2014
Informed Consent
Should be in writing
Should contain the following:
Explanation of procedure, risks
Description of benefits, alternatives
Offer to answer questions about procedure
Instructions that patient may withdraw consent
Statement informing patient if protocol differs
from customary procedure
LD Spring 2014
Voluntary Consent
Valid consent must be freely given, without
coercion
Patient must be at least 18 years of age
(unless emancipated minor)
Consent must be obtained by physician
Patients signature must be witnessed by
professional staff member
LD Spring 2014
Incompetent Patient
Individual who is not autonomous
Cannot give or withhold consent
Cognitively impaired
Mentally ill
Neurologically incapacitated
LD Spring 2014
Preoperative Assessment
Nutritional, fluid status
Dentition
Drug or alcohol use
Respiratory status
Cardiovascular status
Hepatic, renal function
LD Spring 2014
10
Preoperative Assessment
(contd)
Endocrine function
Immune function
Previous medication use
Psychosocial factors
Spiritual, cultural beliefs
LD Spring 2014
11
Latex Allergy
Assessment Tool
Important for the
nurse to assess any
substances that
have previously
precipitated allergic
reactions, including
latex, and to
describe the signs
and symptoms of
the reaction.
LD Spring 2014
12
Medications that Potentially

Affect
on
Surgical
Corticosteroids
Anticoagulants
Experience
Diuretics
Antiseizure
Phenothiazines
Tranquilizers
Insulin
Medications
Thyroid Hormone
Opioids
Antibiotics
LD Spring 2014
13
Question
Which medication classification must be
assessed during the preoperative period

because it can cause an electrolyte imbalance
during surgery?
A.Corticosteroids
B.Diuretics
C.Phenothiazines
D.Insulin
LD Spring 2014
14
Answer
B. Diuretics
Rationale: Diuretics during anesthesia may
cause excessive respiratory depression resulting

from an associated electrolyte imbalance.
Corticosteroids can cause cardiovascular
collapse if discontinued suddenly.
Phenothiazines may increase the hypotensive
action of anesthetics. Interaction between
anesthetics and insulin must be considered
when a patient with diabetes mellitus
undergoes surgery.
LD Spring 2014
15
Patient Teaching
Deep breathing, coughing, incentive
spirometry
Mobility, active body movement
Pain management
Cognitive coping strategies
Instruction for patients undergoing
ambulatory surgery
LD Spring 2014
16
LD Spring 2014
17
Leg Exercises
12
LD Spring 2014
18
General Preoperative
Nursing
Interventions
Providing psychosocial interventions

Reducing anxiety, decreasing fear
Respecting cultural, spiritual, religious beliefs
Maintaining patient safety

Managing nutrition, fluids
Preparing bowel
Preparing skin
LD Spring 2014
19
Immediate Preoperative
Nursing
Interventions
Administering preanesthetic medication

Maintaining preoperative record
Transporting patient to presurgical area
Attending to family needs
LD Spring 2014
20
Question
Tell whether the following statement is true or
false:
The primary goal in withholding food before
surgery is to prevent aspiration.
LD Spring 2014
21
Answer
True.
Rationale: The primary goal in withholding
food before surgery is to prevent aspiration.
LD Spring 2014
22
Pre-op
Checklist
LD Spring 2014
23

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Chapter 17 Unit I

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Chapter 17

decision for surgery until patient is transferred

period of time from the decision for surgery

from customary procedure

Medications that Potentially

assessed during the preoperative period

cause excessive respiratory depression resulting

Providing psychosocial interventions

Maintaining patient safety

Administering preanesthetic medication

food before surgery is to prevent aspiration.

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