An Overview of Preoperative Nursing
You may have heard the term “perioperative nursing” – this encompasses the preoperative, intraoperative, and postoperative phases of the patient’s surgical experience. This video will focus on the preoperative phase – we will look at getting a history & physical, patient education, pre-op checklist, and legal & ethical issues.
The preoperative phase begins when the decision is made for surgical intervention. The pre-op nurse is responsible for assessing the patient’s physical, psychologic, and social states; preparing the patient for surgery; and implementing nursing interventions. The pre-op phase ends when the patient is transported to the operating room and care is transferred to the OR nurse.
The preoperative history and physical done by the nurse may be completed in the doctor’s office, hospital preadmission area, inpatient hospital unit, outpatient surgery facility, or on the phone. It is important for the nurse to identify individuals at risk for intraoperative and postoperative complications, in order to implement interventions that will improve surgical outcomes.
Patient assessments should be individualized and include:
- Identification of the patient with two identifiers, such as name & date of birth
- Mental & physiological status of the patient
- Functional status (patient’s ability to perform ADLs, activities of daily living)
- Cardiovascular & respiratory status
- Skin condition
- Nutritional status (how long has the patient been NPO)
- Range of motion & mobility
- Any prosthetics or corrective devices
- Sensory impairments, language barrier, cultural/spiritual needs
- Previous surgeries & anesthesia experience
-Medications, herbs, nutritional supplements, & drug abuse
The nurse should identify the patient’s support system – their significant other, family, or friends that are present.
The key nursing intervention during the preoperative period is patient and family education. Take every opportunity during the patient assessment and preparation for surgery, to provide information that will increase the patient’s familiarity with the procedure, which will decrease anxiety. Give instructions on activities that will promote healing and prevent postoperative complications. Assess and address individual learning needs, and involve patients in decision making concerning their care – this allows them to maintain some control over events. During the pre-op assessment, teach the patient about postoperative pain control. Fear of pain is a common source of anxiety and should be addressed before surgery, to decrease anxiety and add to the patient’s sense of control.
A pre-op checklist is a way for the nurse to summarize patient data and ensure the patient is ready for surgery. The patient should remove all personal clothing and put on a hospital gown. Jewelry is removed, according to hospital policy. Patient’s personal belongings, including eyeglasses, dentures or prostheses, are identified and secured. Confirm the patient’s name & DOB on the ID band; confirm that consent forms are completed & signed; x-rays, lab results, and EKG are on the chart; verify the availability of an implant if needed, and the availability of blood.
To ensure patient safety, the Universal Protocol is a mandatory Joint Commission quality standard that verifies correct patient identity, correct procedure, and correct surgical site. At least two patient identifiers are used to verify patient identity, such as asking the patient to state their full name and date of birth. The patient should verbally confirm the surgical procedure and the surgeon should mark the surgical site with the patient’s involvement. The pre-procedure verification and surgical site marking are performed in the pre-op area, then the “timeout” is done in the OR immediately prior to surgery.
Depending on the anesthesiologist’s preference, premedication may be given by the pre-op nurse to decrease anxiety and provide sedation, to prevent or decrease nausea and vomiting, to decrease gastric volume and acidity, to decrease secretion of saliva and gastric juices, and to relieve pain and discomfort. Once premedication has been given, ensure patient safety by keeping the patient in bed with side rails up.
There are certain legal and ethical issues that need to be addressed when a patient is going to have surgery. Informed consent refers to the process in which the patient is informed of the nature, consequences, harms, benefits, risks, and alternatives to the proposed medical treatment. Before surgery, the physician asks the patient to sign a statement consenting to the surgical procedure. The physician is legally responsible for providing the patient with sufficient information to weigh the risks and benefits of the surgery, which includes the disease process and diagnosis; nature of the surgery with its benefits, risks, and prognosis if treatment is withheld; and alternative treatment options. The informed consent must include the patient’s full legal name; surgeon’s name; specific procedure(s) to be performed; signature of the patient, next of kin, or legal guardian; witness (which is usually the nurse); and the date.
The nurse’s role is that of patient advocate. The nurse assess the patient’s decision-making capacity, confirms that the patient has received the necessary information to give informed consent, and clarifies any misunderstandings. The nurse should also support the patient’s decision, should the patient decide to withdraw informed consent and refuse the surgical procedure.
Health care providers are required to inform patients of their rights in decision making regarding health care choices. Advance directives allow the individual to specify their preferences for treatment, should they become unable to make independent health care decisions. Examples of advance directives include a living will and durable power of attorney. A living will outlines the patient’s wishes regarding medical treatment, life support, and resuscitation measures. The durable power of attorney identifies the person who is authorized to make healthcare decisions on the patient’s behalf if the patient becomes incapacitated. The perioperative nurse must be aware of a patient’s decisions regarding advance directives.
The pre-op nurse will document the patient care and teaching given during the preoperative phase. Pertinent data will be communicated to the OR nurse, as care is transferred over.
Thank you for watching this video about preoperative nursing. Be sure to check out our other videos!