BAKERSFIELD COLLEGE
LICENSED VOCATIONAL NURSING PROGRAM
1ST SEMESTER FUNDAMENTALS
CLIENTS WITH SPECIAL NEEDS
CHAPTER 50 - THE SURGICAL CLIENT: PREOPERATIVE CARE
INTRODUCTION
The goal of this module is to assist you in providing adequate emotional and physical support to clients and family members during a client’s surgical experience. The anticipation of surgery produces considerable fear in the client who faces many unknowns.
OBJECTIVES
Upon completion of this unit, the student will be able to:
A. Theory
1. Define Perioperative nursing.
2. List four pathological processes responsible for most surgical conditions and give an example of a surgical condition for each process.
3. List the three major classifications for all surgical procedures.
4. List and describe the five purposes of surgery.
5. Describe three conditions that increase a person’s surgical risk.
6. Identify and state the purpose of lab work and tests that might be ordered preoperatively.
7. List factors to include in the preoperative assessment of the surgical client.
8. Identify who is responsible to provide information for the informed consent.
9. State what the nurse’s signature on a consent form means.
10. Identify who can sign a surgical consent.
11. Describe how fear and anxiety is expressed by the surgical client.
12. List each step of the preoperative check list.
13. Identify medications and their purpose that are used as preops.
B. Laboratory
1. Demonstrate postoperative exercises: diaphragmatic breathing, coughing, turning, and leg exercises.
ASSIGNMENT
A. Read Chapter 50- Potter & Perry –pgs. 1365 – 1390, omit N/G’s, Critical Thinking Exercise # 2 and Review Questions
B. Study Guide for Chapter 50
· Chapter 50 The Surgical Client
· Preoperative Care
o The goal of this unit is to assist you in providing adequate emotional and physical support to clients and family members during a surgical experience
· The anticipation of surgery produces considerable fear in the client who faces many unknowns
· History of Surgical Nursing
· Nursing played a major role in disease prevention.
· Early surgical nurses
o Cleaned rooms and equipment, obtained supplies, cared for clients postoperatively
· Association of Operating Room Nurses
o Established 1956
· Ambulatory surgery
o Perioperative Nursing
· Refers to the role of the operating nurse during the preoperative, intraoperative, and postoperative phases of surgery
· In some institutions this is the way it is done and in others different nurses care for the client during each phase of the surgical experience
· Four Pathological Processes Responsible for Surgical Conditions
· Obstruction
o blocks flow of body substances
· Perforation
o Rupture of body part
· Erosion
o Result of continuous irritation; infection
· Tumors
o Benign or malignant
· Classification of Surgery
· Seriousness
o Major
§ Length of procedure
§ Blood loss
§ Risk of post-op complications
o Minor
§ Brief procedure
§ Minimal risk
· Urgency
o Elective
§ Performed for client’s well being
§ Not absolutely necessary
o Urgent
§ Necessary for client’s health
§ Prevent additional problems
o Emergency
§ Immediate need to save a life
§ Preserve a body part
· Purpose – Why it is done
o Diagnostic
§ To confirm diagnosis
o Ablative
§ Excise or remove diseased body part
o Palliative
§ Relieve symptoms
o Reconstructive
§ Restores function or appearance
o Transplant
§ Replace organs
o Constructive
§ Restores function lost from congenital anomalies
- Cosmetic
§ To improve appearance
· Preoperative Surgical Phase
· Surgical clients enter the health care setting in different stages of health
· Some enter with a planned surgery and some through the emergency department
· Assessment
· History
o client age
o Past illnesses and surgeries
o Medical conditions
· Review client and family members understanding and perception of surgery
· Medication history
· Smoking habits
o Risk for respiratory complications
· Alcohol ingestion
o Reactions to anesthesia
o Need more analgesia post-op
· Family support
o Provide assistance during recovery
· Occupation
o May not be able to return to former job
· Review of emotional health
o Verbalize fears and feelings
· Physical exam
o Focus on body systems affected by surgery
o Monitor vital signs
· Estimation of Surgical Risk
· Physical and Mental Condition
o Clients at risk
§ Age
§ Obesity
§ Fluid or electrolyte imbalance
· Extent of Disease
· Magnitude of Operation
· Resources and Preparation of:
o Surgeon, nurses, hospital
· Nursing Diagnosis
· Preoperative diagnoses:
o Fear
o Knowledge deficit
o Risk for ineffective airway clearance
· Planning and Implementation
o Informed consent
§ Client must understand procedure and risks
§ Physician responsibility to inform client
§ Client must be alert and oriented
§ Client signature implies he is informed
§ Witnessed by member of health care team
§ Nurse verifies consent with client
§ Check for time limit on signed consent
§ Nurse witness verifies only client signed consent
· Who can sign the consent form?
· Legal age
· Underage but married
· Emancipated minor
· Without legal guardianship
· Parent or guardian of minor
· Spouse or next of kin for unconscious or mentally incompetent
· Telephone consent obtained by 2 witnesses – or telegram
· Court order
· Emergency situations the surgeon can perform without a consent
· Preoperative Teaching
· Office or home setting
o Printed literature
o Video tapes
· Admission or pre-admission nurses
o Educate clients and family members
· Better prepared and less anxious
· AORN Criteria
· Client sites reasons for each of preop instructions
o Diaphragmatic breathing
§ Improves lung expansion
o Incentive spirometry
o Controlled coughing
§ Removes secretions
o Turning
§ Improves blood flow
o Leg exercises
§ Prevents clots
· The client states the time surgery is scheduled
· The client states the unit to which he will return to after surgery
· The client discusses anticipated monitoring and therapeutic devices
· The client describes the scheduled procedure and treatment plan
· The client describes anticipated recovery steps
· The client verbalizes expectations of pain and pain relief measures
· The client expresses feelings regarding the surgical intervention and the expected outcome
· Physical preparation
· Maintenance of normal fluid and electrolyte balance
o NPO at midnight
o May brush teeth and rinse without swallowing water
o Notify MD if client eats or drinks during NPO period
· Minimize the risk of surgical wound infection
o Bath evening before surgery with antimicrobial soap
o Skin prep or shave
· Prevent bowel and bladder incontinence
o Absence of peristalsis for 24 hrs >
· Promote rest and comfort
o Provide a quiet environment
o Administer sedative-hypnotic
o Day of Surgery
pre-op checklist
· Check the chart
· Check and record vital signs
· Provide hygiene
· Check hair and cosmetics
· Remove prosthetics
· Void before pre-op medications
o Empty foley or insert one if ordered
· Check anti-embolic stockings
· Promote client dignity
· Perform special procedures
o Start IV
o NG
o Foley
· Safeguard valuables
· Preop Medications
o Barbituates
§ Decrease anxiety, BP and pulse
o Tranquilizers
§ Decrease anxiety and BP
o Narcotic analgesics
§ Provide sedation
§ Reduce pain
§ Decrease amount of anesthesia
o Anticholinergics
§ Decrease mucous secretions
o “On call”
§ Meds may be given on call to OR
o After administration of preops
§ Side rails up
§ Lights low
§ Bed in low position
§ Family may remain quietly with patient