An Overview of Preoperative Nursing
Welcome to this video tutorial on 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 and physical, patient education, pre-op checklist, and legal and 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 and date of birth
- Mental and physiological status of the patient
- Functional status (patient’s ability to perform ADLs, activities of daily living)
- Cardiovascular and respiratory status
- Skin condition
- Nutritional status (how long has the patient been NPO)
- Range of motion and mobility
- Pain
- Any prosthetics or corrective devices
- Sensory impairments, language barrier, cultural/spiritual needs
- Anxiety
- Previous surgeries and anesthesia experience
- Allergies
- Medications, herbs, nutritional supplements, and 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 assesses 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!
Frequently Asked Questions
Q
What are the three phases of perioperative nursing?
A
The three phases of perioperative nursing include the preoperative, intraoperative, and postoperative phases. Perioperative nursing is governed by the guidelines recommended by the Association of periOperative Registered Nurses (AORN).
Q
What is preoperative nursing care?
A
Preoperative nursing care comprises the responses of the nurse that is preparing a patient for an operation or procedure.
Q
What are the responsibilities of a preoperative nurse?
A
Critical responsibilities of the preoperative nurse include collecting the patient’s history, conducting a preoperative assessment, and prepping the patient for the procedure (including getting the patient appropriately dressed, inserting an IV when necessary, administering ordered IV fluids and preoperative medications, and documenting with timestamps when each of these steps occurred). The preoperative nurse is also responsible for ensuring that consent has been obtained for both the procedure and anesthesia (if anesthesia will be provided), confirming whether the patient has an advanced directive on file, and advocating for the patient with regards to any questions or concerns they have prior to their procedure.
Q
What is included on the preoperative checklist?
A
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 the procedure being performed and hospital policy. The 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 informed 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.
Q
What elements of the patient’s history are relevant to the preoperative nurse?
A
The patient’s history is collected prior to patient arrival for their procedure (when possible) through a preoperative phone call made by a preoperative nurse. Patient history is then reviewed again in the preoperative phase. Elements discussed include allergies, exposures to infectious disease, past and current physical and mental illness, smoking and alcohol/drug use, screening for obstructive sleep apnea, screening for domestic violence, and previous experiences with anesthesia.
Q
What does the physical assessment of a preoperative nurse include?
A
The physical assessment includes collecting baseline vitals (heart rate and rhythm, oxygen saturation, respiratory rate, blood pressure, and pain), height and weight, a head-to-toe assessment of the patient, and any prep-related assessments (following NPO guidelines, withholding drugs prior to procedure as ordered, completing any bowel preparatory regiments, etc.). Additionally, patients with diabetes generally will have a blood sugar level drawn to confirm the glycemic stability.
Q
What is the Universal Protocol?
A
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.
Q
What is informed consent?
A
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. If anesthesia is being administered the patient must sign a separate consent for anesthesia after the anesthesiologist has explained the same elements required for surgical consent.