Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Perioperative: Preoperation Surgery

Safety A Allergy B Bleeding C Cortisone / Steroids D Diabetes E Embolus What is Surgery? - It is the assessment of a disease, injury, or deformity by means of manual / instrumental operations TYPES OF SURGERY BASED ON PURPOSE AND URGENCY PURPOSE Classification Diagnostic Explorative Palliative Reconstructive Curative Transplant Purpose Confirmation of suspected diagnosis Confirms the type and extent of a disease process Alleviates pain / other disease symptoms, slows progression of disease but does not care Repairs physical deformity / improves appearance Diseased / damaged body organ structure is removed or repaired and the client is cured Diseased / damaged body organs replaced with donated / artificial organs

URGENCY Emergent Urgent Elective

Preserves function of body parts or life of client Requires prompt attention within 24 48 hours Satisfies clients desires but not needed to preserve life of function

Assessment
Assess patients diagnostic and planned surgery Assess the clients surgical history Assess for complicating factors Assess for any allergies Assess the client for false teeth Determine when NPO status was initiated Assess patients level of understanding Make sure signed consent has been obtained

Diagnosis
Knowledge deficit r/t surgery and the post operational course o Anxiety o Fear

Planning
The patient will experience less anxiety, subsequent to appropriate instructions The patient will not experience any adverse reactions caused by inadequate physical preparation

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The patient will not experience any loss of belongings or possessions during the surgery / recovery period The patient will not experience any disruptions or delays of the surgery caused by poor preoperational care or planning Planning: Equipment BP Stethoscope Flash light Pre-op Check list Container for dentures, glasses Appropriate storage for valuables and clothes Information packets regarding surgery Surgical consent forms indicating risk IV fluids, needles, and equipment as needed Preoperational medications Transfer cart

Client Education Needed

Ascertain what information has been provided to the client by the physician / qualified practitioner If the client has further questioning, answer as appropriate Remind the client that there are no dumb questions Explain the need for removal of rings, dentures, prosthesis, contacts, or glasses Explain the reason for not eating prior to the surgery Inform the client of what to expect pre-op and post-op Long waits in the operation room suite can be frightening if this is not anticipated, especially if the patient does not know what to expect Transfer the patient directly to another staff member. Do not move the patient to OR waiting area and leave unattended

Implementation
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Wash hands Verify admission orders regarding type of surgery, risk (including recent change4s in VS) and client preparation Verify the client by checking name tag and asking name Check whether the client has any questions regarding the surgery and understand the procedure Complete the pre-op check list Perform neurological assessment, including checks for orientation, eye coordination, hand grips, knee bends and plantar and dorsiflexion of the feet Perform vascular assessment, including check for pulse, BP and apical pulse, rhythm, peripheral pulses and temperature. Compare with previous information. Patient over 50 may require EG Auscultate the lungs bilaterally front and back if any wheezes, rhonchi, coughs, URI, or increased temperature, notify the physician or qualified practitioner Assess the GI system (Time of last meal, food, allergies, bowel sounds, last bowel movement, time of last liquid) Assess genital / urinary system (LMP, last void, state of pregnancy, estrogen replacement therapy) Assess skin and muscle tone for any skin breakdown, redness, bruises, decreased skin integrity Ascertain any allergies / adverse reactions during previous surgeries / use of anesthesia Obtain medication history, including the time and date of the last dose of medication Ascertain any history of drugs / alcohol use and when they were last used Check weight Check if family is available and who is present Ascertain if patient has signed the surgical consent. Determine if the client has a living will or has designated resuscitation status

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18. Remove all valuables with the exception of wedding rings if requested. Tape rings in place. Check and document whether valuables are placed in a locked area, safe storage area or given to family 19. Check if eye glasses and dentures are removed, placed in a labeled container 20. Administer IV fluid according to order 21. Administer medications according to order 22. Ascertain that preoperational check list is complete 23. Transfer the patient to appropriate are

Evaluation
The client experienced less anxiety subsequently to appropriate instruction The patient did not experience any adverse reactions The client did not experience any loss of belongings / possession The client did not experience any disruption / delay of the surgery caused by poor preoperational care / planning

Documentation
Preoperational Check List o Fill out and initial the pre-op check list o Note any unusual findings Nurses Notes o Document any ** findings from the pre-op check list o Note any pre-op teaching o Document the disposition of client valuables Medication Administer Reconst. - Note any pre op

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