STATE COLLEGE OF NURSING, 107,CHANDER

NAGAR,DEHRADUN

PRACTICE TEACHING
Nursing Education
on
PRE-OPERATIVE PHASE
Submitted to:
Mrs. Asha Gangola
Assistant propfessor
SCON Dehradun, Uttarakhand
Submitted by:
Rakhi Yadav
M.Sc. Nursing [MSN] I year
SCON Dehradun, Uttarakhand
Submitted on:
/ /2016
SUBJECT : NURSING EDUCATION

TOPIC : PRE-OPERATIVE PHASE

GROUP : B.Sc. NURSING 1stYear

PLACE : B.Sc. NURSING 1stYearCLASS ROOM

DATE :

TIME : 45 MIN

TEACHING METHOD : LECTURE CUM DISSCUSSION

INSTRUCTIONAL AIDS : BLACK BOARD, CHART, OVER HEAD PROJECTOR, POWER POINT
PRESENTATION, VIDEOCLIP, LEAFLET

PREVIOUS KNOWLEDGE OF STUDENTS: THE STUDENT SHOULD KNOW ABOUT OERATION AND PRE
OPERATION PREPARATION
 GENERAL OBJECTIVE:
At the end of the class student will acquire adequate knowledge regarding pre-operative phase, its principles, preparation done
and nurses responsibility and apply this knowledge& skill in clinical practice and hospitals while handling any caring any
patient who are going to have a surgery

SPECIFIC OBJECTIVE: At the end of the class student will be able to-
1. Define preoperative phase
2. List-out the goals of preoperative phase
3. Describe purpose of preoperative phase
4. Explain the various component of Pre-operative phase
5. Discuss the nursing management of pre-operative phase
 INTRODUCTION:

Surgery whether elective or emergent, is a stressful, complex event. The special field known as peri-operative and peri-anesthesia
nursing includes a wide variety of nursing functions. It is the phase when the patient had decided for surgical intervention up to the
time of transfer to the operating room.There is 3 phases of surgery that is pre-operative, intra-operative and postoperative.
Preoperative care is the preparation and management of a patient prior to surgery. It includes both physical and psychological
preparation. During the pre – operative phase, assessment is done in terms of age of the patient, by which young children and older
adults are the most vulnerable to complications; the patient’s nutritional status, where in post op recovery usually relies; fluid and
electrolyte status, because hydration is important to prevent hypovolemia during surgery; presence of infection and other health
problems, since it can predispose the patient for sepsis and other unwanted conditions post operatively; the holistic bodily functions,
clearance from cardio, respiratory, renal, neurologic, hematologic and other pertinent functions prior to procedure is really a routine to
avoid life threatening situations during and after the surgical procedure; use of medications like anticoagulants, to prevent
hemorrhagic complications; as well as health habits like smoking and sedentary lifestyle, in order to assess the possible needed health
teachings suited for the patient. The preoperative phase can range from minutes to months. For a patient who has been diagnosed with
a critical illness that must be corrected with surgery, the time from diagnosis to surgery may be measured in minutes. Those types of
situations are usually caused by a traumatic injury or massive bleeding. For patients with a surgery planned in advance, the
preoperative period may last for months. Some patients require extensive testing to determine whether they are able to tolerate the
stresses of surgery and anesthesia Preoperative testing can range from having a few blood tests to having a full cardiac workup to
determine if the heart is working properly.
 Teaching
S.NO Time Specific Content learning activity Evaluation
objectives with Audio-
Visual Aids
1. 2 min To define DEFINITIONS: Teacher activity: Define
preoperative  Preoperative care the psychologic and physiologic preparati Define preoperative preoperative
phase on of a patient before an operation. The preoperative period phase with the help phase?
may be extremely short, as with an emergency operation, or of power point
it may encompass several weeks during which diagnostics, presentation.
specific medications and treatments, and measures to Learner activity:
improve the patient's general wellbeing are employed in Students are
preparation for surgery. listening and writing
Medical Dictionary

 The Preoperative phase is the time period between the

decision to have surgery and the beginning of the surgical
procedure

GOALS OF PREOPERATIVE PHASE Teacher activity: Tell any 2 goals

2. 4 min To list-out the List-out the goals of of pre-operative
goals of Although the physician is responsible for explaining the preoperative phase phase?
preoperative surgical procedure to the patient, the patient may ask the nurse with the help of
phase questions about the surgery. There may be specific learning power point
needs about the surgery that the patient and support persons presentation and
should know. A nursing care plan and a teaching plan should be OHP
carried out. During this phase, emphasis is placed on: Learner activity:
 Assessing and correcting physiological and psychological Students are writing
problems that may increase surgical risk.
 Giving the patient and significant others complete learning
and teaching guidelines regarding the surgery.
 Instructing and demonstrating exercises that will benefit the
patient postoperatively.
 Planning for discharge and any projected changes in
lifestyle due to the surgery.
 PURPOSE Teacher activity: Why
3 4 min To describe Describe purpose of preoperative
purpose of Patients who are physically and psychologically prepared for preoperative phase phase is
preoperative surgery tend to have better surgical outcomes. Preoperative with the help of important prior
phase teaching meets the patient's need for information regarding the power point to surgery?
surgical experience, which in turn may alleviate most of his or presentation
her fears. Patients who are more knowledgeable about what to
Learner activity:
expect after surgery, and who have an opportunity to express
Students are writing
their goals and opinions, often cope better with postoperative
pain and decreased mobility. Preoperative care is extremely
important prior to any invasive procedure, regardless of
whether the procedure is minimally invasive or a form of major
surgery.
Preoperative teaching must be individualized for each patient.
Some people want as much information as possible, while
others prefer only minimal information because too much
knowledge may increase their anxiety.

4 20 min To explain the COMPONENTS OF CARE IN PREOPERATIVE Teacher activity:

various PHASE Explain the various What do you
component of 1. PHYSICAL PREPARATION: - It consists of :- component of Pre- understand by
Pre-operative operative phase with Latex allergy?
phase  Complete medical history and physical exam, including the help of power
the patient's surgical and anesthesia background. The
point presentation,
patient should inform the physician and hospital staff if he
or she has ever had an adverse reaction to anesthesia (such videoclip , flashcard
as anaphylactic shock), or if there is a family history of and chart
malignant hyperthermia. Learner activity:
 Laboratory tests may include complete blood count, Students are writing
electrolytes, prothrombin time, activated partial
thromboplastin time, and urinalysis. The patient will most
likely have an electrocardiogram (EKG) if he or she has a
history of cardiac disease, or is over 50 years of age.
 A chest x ray is done if the patient has a history of
respiratory disease.
 Part of the preparation includes assessment for risk factors
that might impair healing, such as nutritional
deficiencies, steroid use, radiation or chemotherapy, drug or
 alcohol abuse, or metabolic diseases such as diabetes. The
patient should also provide a list of all medications,
vitamins, and herbal or food supplements that he or she
uses. Supplements are often overlooked, but may cause
adverse effects when used with general anesthetics (e.g., St.
John's wort, valerian root). Some supplements can prolong
bleeding time (e.g., garlic, gingko biloba).
 Latex Allergy has become a public health concern. Latex
is found in most sterile surgical gloves, and is a common
component in other medical supplies including general
anesthesia masks, tubing, and multi-dose medication vials.
It is estimated that 1–6% of the general population and 8–
17% of health care workers have this allergy. Children with
disabilities are particularly susceptible. This includes
children with Spina bifida, congenital urological
abnormalities, cerebral palsy, and Dandy-Walker
syndrome. At least 50% of children with spina bifida are
latex-sensitive as a result of early, frequent surgical
exposure. There is currently no cure available for latex
allergy, and research has found that the allergy accounts for
up to 19% of all anaphylactic reactions during surgery.
Latex-free gloves and supplies must be used for anyone
with a documented latex allergy.
 Bowel clearance may be ordered if the patient is having
surgery of the lower gastrointestinal tract. The patient
should start the bowel preparation early the evening before
surgery to prevent interrupted sleep during the night. Some
patients may benefit from a sleeping pill the night before
surgery.
 The night before surgery, skin preparation is often
ordered, which can take the form of scrubbing with a
special soap (i.e., Hibiclens), or possibly hair removal from
the surgical area. Shaving hair is no longer recommended
because studies show that this practice may increase the
chance of infection. Instead, adhesive barrier drapes can
contain hair growth on the skin around the incision.
 The following are the physiologic assessments necessary
during the preoperative phase:
 Age and Obtain a health history and perform a physical
examination to establish vital signs and a database for
future comparisons.
 Assess patient’s usual level of functioning and typical
daily activities to assist in patient’s care and recovery or
rehabilitation plans.
 Assess mouth for dental caries, dentures, and partial plates.
Decayed teeth or dental prostheses may become dislodged
during intubation for anesthetic delivery and occlude the
airway.
 Nutritional status and needs – determined by measuring the
patient’s height and weight, triceps skinfold, upper arm
circumference, serum protein levels and nitrogen balance.
Obesity greatly increases the risk and severity of
complications associated with surgery.
 Fluid and Electrolyte Imbalance – Dehydration,
hypovolemia and electrolyte imbalances should be carefully
assessed and documented.
 Drug and alcohol use – the acutely intoxicated person is
susceptible to injury.
 Respiratory statuses – patients with pre-existing pulmonary
problems are evaluated by means pulmonary function
studies and blood gas analysis to note the extent of
respiratory insufficiency.
 Cardiovascular status – cardiovascular diseases increases
the risk of complications. Depending on the severity of
symptoms, surgery may be deferred until medical treatment
can be instituted to improve the patient’s condition.
 Hepatic and renal function – surgery is contraindicated in
patients with acute nephritis, acute renal insufficiency with
oliguria or anuria, or other acute renal problems. Any
disorder of the liver on the other hand, can have an effect
on how an anesthetic is metabolized.
 Endocrine function – diabetes, corticosteroid intake,
amount of insulin administered
 Immunologic function
 Previous medication therapy – It is essential that the
 patient’s medication history be assessed by the nurse and
anesthesiologist.

2. PSYCHOLOGICAL PREPARATION
Patients are often fearful or anxious about having surgery. It is What is Patient
often helpful for them to express their concerns to health care psychological
workers. This can be especially beneficial for patients who are preparation ?
critically ill, or who are having a high-risk procedure. The
family needs to be included in psychological preoperative care..
If the patient has a fear of dying during surgery, this concern
should be expressed, and the surgeon notified. In some cases,
the procedure may be postponed until the patient feels more
secure. Children may be especially fearful. They should be
allowed to have a parent with them as much as possible, as long
as the parent is not demonstrably fearful and contributing to the
child's apprehension..Patients and families who are prepared
psychologically tend to cope better with the patient's
postoperative course. Preparation leads to superior outcomes
since the goals of recovery are known ahead of time, and the
patient is able to manage postoperative pain more effectively.
Psychological nursing assessment during the preoperative
period:
 Fear of the unknown
 Fear of death
 Fear of anesthesia
 Concerns about loss of work, time, job and support from
the family
 Concerns on threat of permanent incapacity
 Spiritual beliefs
 Cultural values and beliefs
 Fear of pain

3. INFORMED CONSENT
The patient's or guardian's written consent for the surgery is a
vital portion of preoperative care. By law, the physician who
will perform the procedure must explain the risks and benefits
of the surgery, along with other treatment options. However,
the nurse is often the person who actually witnesses the
patient's signature on the consent form. It is important that the
patient understands everything he or she has been told.
Sometimes, patients are asked to explain what they were told so
that the health care professional can determine how much is
understood.Patients who are mentally impaired, heavily
sedated, or critically ill are not considered legally able to give
consent. In this situation, the next of kin (spouse, adult child, Tell the criteria
adult sibling, or person with medical power of attorney) may for taking
act as a surrogate and sign the consent form. Children under age informed
18 must have a parent or guardian sign. consent?
Criteria for a Valid Informed Consent
 Consent voluntarily given. Valid consent must be freely
given without coercion.
 For incompetent subjects, those who are NOT autonomous
and cannot give or withhold consent, permission is required
from a responsible family member who could either be
apparent or a legal guardian. Minors (below 18 years of
age), unconscious, mentally retarded, psychologically
incapacitated fall under the incompetent subjects.
 The consent should be in writing and should contain the
following:
 Procedure explanation and the risks involved
 Description of benefits and alternatives
 An offer to answer questions about the procedure
 Statement that emphasizes that the client may withdraw the
consent
 The information in the consent must be written and be
delivered in language that a client can comprehend.
 Should be obtained before sedation.

4. PREOPERATIVE TEACHING
Preoperative teaching includes instruction about the
preoperative period, the surgery itself, and the postoperative
period.
 Instruction about the preoperative period deals primarily
 with the arrival time, where the patient should go on the Tell about
day of surgery, and how to prepare for surgery. For respiratory
example, patients should be told how long they should be exercise?
NPO (nothing by mouth), which medications to take prior
to surgery, and the medications that should be brought with
them (such as inhalers for patients with asthma).
 Instruction about the surgery itself includes informing the
patient about what will be done during the surgery, and
how long the procedure is expected to take. The patient
should be told where the incision will be
 Knowledge about what to expect during the postoperative
period is one of the best ways to improve the patient's
outcome. Instruction about expected activities can also
increase compliance and help prevent complications. This
includes the opportunity for the patient to practice coughing
and deep breathing exercises, use an incentive spirometer,
and practice splinting the incision. Additionally, the patient
should be informed about early ambulation (getting out of
bed).
 The patient should also be taught that the respiratory
interventions decrease the occurrence of pneumonia, and
that early leg exercises and ambulation decrease the risk of
blood clots.
 Patients hospitalized postoperatively should be informed
about the tubes and equipment that they will have. These
may include multiple intravenous lines, drainage tubes,
dressings, and monitoring devices. In addition, they may
have sequential compression stockings on their legs to
prevent blood clots until they start ambulating.
 Pain management is the primary concern for many
patients having surgery. Preoperative instruction should
include information about the pain management method
that they will utilize postoperatively. Patients should be
encouraged to ask for or take pain medication before the
pain becomes unbearable, and should be taught how to rate
their discomfort on a pain scale. If they will be using
a patient-controlled analgesia pump, instruction should
take place during the preoperative period. Use of
 alternative methods of pain control (distraction, imagery,
positioning, mindfulness meditation, music therapy) may
also be presented.
 Finally, the patient should understand long-term goals such
as when he or she will be able to eat solid food, go home,
drive a car, and return to work.

5. PREPARATION
It is important to allow adequate time for preparation prior to
surgery. The patient should understand that he or she has the
right to add or strike out items on the generic consent form that
do not pertain to the specific surgery. For example, a patient
who is about to undergo a tonsillectomy might choose to strike
out (and initial) an item that indicates sterility might be a
complication of the operation.

6. GERONTOLOGIC CONSIDERATIONS
 Monitor older patients undergoing surgery for subtle clues
that indicate underlying problems since elder patients have
less physiologic reserve than younger patients.
 Monitor also elderly patients for dehydration, hypovolemia,
and electrolyte imbalances.

Teacher activity: What is a nurse

5 15 min To discuss the Discuss the nursing role in
nursing NURSING MANAGEMENT management of pre- psychological
management of operative phase preparation of
pre-operative Assessment : with the help of patient?
phase Assess for patient physical, psychological, spiritual, and social power point
needs. Handle patient according to age group and take inform-
presentation and
consent is important task of the preoperative phase for nurse.
Thorough physical assessment and history collection is too leaflet
important. Learner activity:
Students are
listening and writing
Nursing interventions:
1. Reducing Anxiety and Fear:
 Provide psychosocial support.
 Be a good listener, be empathetic, and provide
information that helps alleviate concerns.
 During preliminary contacts, give the patient
opportunities to ask questions and to become acquainted
with those who might be providing care during and after
surgery.
 Acknowledge patient concerns or worries about
impending surgery by listening and communicating
therapeutically.
 Explore any fears with patient, and arrange for the
assistance of other health professionals if required.
2. Managing Nutrition and Fluids:
 Provide nutritional support as ordered to correct any
nutrient deficiency.
 Instruct patient that oral intake of food or water should
be withheld 8 to 10 hours before the operation (most
common), unless physician allows clear fluids up to 3 to 4
hours before surgery.
 Inform patient that a light meal may be permitted on
the preceding evening when surgery is scheduled in the
morning, or provide a soft breakfast, if prescribed, when
surgery is scheduled to take place after noon and does not
involve any part of the GI tract.
 In dehydrated patients, and especially in older
patients, encourage fluids by mouth, as ordered, before
surgery, and administer fluids intravenously as ordered.
 Monitor the patient with a history of chronic alcoholism
for malnutrition and other systemic problems that increase
the surgical risk as well as for alcohol withdrawal
3. Promoting Optimal Respiratory and Cardiovascular
Status:
 Urge patient to stop smoking 2 months before surgery (or at
least 24 hours before).
 Teach patient breathing exercises and how to use an
 incentive spirometer if indicated.
 Assess patient with underlying respiratory disease
(eg, asthma, chronic obstructive pulmonary disease
[COPD]) carefully for current threats to pulmonary status;
assess patient’s use of medications that may affect
postoperative recovery.
 In the patient with cardiovascular disease, avoid
sudden changes of position, prolonged immobilization,
hypotension or hypoxia, and overloading of the circulatory
system with fluids or blood.
4. Supporting Hepatic and Renal Function
 If patient has a disorder of the liver, carefully assess
various liver function tests and acid–base status.
 Frequently monitor blood glucose levels of the patient
with diabetes before, during, and after surgery.
 Report the use of steroid medications for any purpose by
the patient during the preceding year to the anesthesiologist
and surgeon.
5. Monitor patient for signs of adrenal insufficiency.
 Assess patients with uncontrolled thyroid disorders for a
history of thyrotoxicosis (with hyperthyroid disorders) or
respiratory failure (with hypothyroid disorders).
6. Promoting Mobility and Active Body Movement
 Explain the rationale for frequent position changes after
surgery (to improve circulation, prevent venous stasis, and
promote optimal respiratory function) and show patient
how to turn from side to side and assume the lateral
position
 Discuss any special position patient will need to
maintain after.
 Instruct patient in exercises of the extremities,
including extension and flexion of the knee and hip joints
and range of motion of the elbow and shoulder.
 Use proper body mechanics, and instruct patient to do
the same. Maintain patient’s body in proper alignment
when patient is placed in any position.
7. Respecting Spiritual and Cultural Beliefs
 Help patient obtain spiritual help if he or she requests
 it; respect and support the beliefs of each patient.
 Ask if the patient’s spiritual adviser knows about
the impending surgery.
 When assessing pain, remember that some cultural groups
are unaccustomed to expressing feelings openly.
Individuals from some cultural groups may not make direct
eye contact with others; this lack of eye contact is not
avoidance or a lack of interest but a sign of respect.
8. Providing Preoperative Patient Education
 Teach each patient as an individual, with consideration
for any unique concerns or learning needs.
 Begin teaching as soon as possible, starting in the
physician’s office and continuing during the pre admission
visit, when diagnostic tests are being performed, through
arrival in the operating room.
 During the preadmission visit, arrange for the patient
to meet and ask questions of the perianesthesia nurse,
view audiovisuals, and review written materials. Provide a
telephone number for patient to call if questions arise closer
to the date of surgery.
9. Teaching the Ambulatory Surgical Patient
 For the same day or ambulatory surgical patient, teach
about discharge and follow-up home care. Education can be
provided by a videotape, over the telephone, or during a
group meeting, night classes, preadmission testing, or the
preoperative interview.
 Answer questions and describe what to expect.
10. Teaching Deep Breathing and Coughing Exercises
 Teach the patient how to promote optimal lung
expansion and consequent blood oxygenation after
anesthesia by assuming a sitting position, taking deep and
slow breaths (maximal sustained inspiration), and exhaling
slowly.
 Demonstrate how patient can splint the incision line
to minimize pressure and control pain (if there will be a
thoracic or abdominal incision).
 Inform patient that medications are available to relieve pain
and that they should be taken regularly for pain relief to
 enable effective deepbreathing and coughing exercises.
11. Explaining Pain Management
 Instruct patient to take medications as frequently as
prescribed during the initial postoperative period for pain
relief
12. Preparing the Bowel for Surgery
 If ordered preoperatively, administer or instruct the
patient to take the antibiotic and a cleansing enema or
laxative the evening before surgery and repeat it the
morning of surgery.
13. Preparing Patient for Surgery
 If hair is to be removed, remove it immediately before
the operation using electric clippers.
 Dress patient in a hospital gown that is left untied and
open in the back.
 Cover patient’s hair completely with a disposable paper
cap; if patient has long hair, it may be braided; hairpins are
removed.
14. Remove jewelry, including wedding rings
15. Transporting Patient to Operating Room
 Send the completed chart with patient to operating
room; attach surgical consent form and all laboratory
reports and nurses’ records, noting any unusual last minute
observations that may have a bearing on the anesthesia or
surgery at the front of the chart in a prominent place.
 Take the patient to the preoperative holding area, and
keep the area quiet, avoiding unpleasant sounds or
conversation.
16. Attending to Special Needs of Older Patients
17. Attending to the Family’s Needs
18. Spiritual Considerations
 SUMMARY :

The pre-op phase is an important phase of peri-operative nursing. The preoperative phase is used to perform tests, attempt to
limit preoperational anxiety and may include the fasting. The patient who consents to have surgery, particularly surgery that requires a
general anesthetic, renders himself dependent on the knowledge, skill, and integrity of the health care team. In accepting this trust, the
health care team members have an obligation to make the patient's welfare their first consideration during the surgical experience. The
scope of activities during the preoperative phase includes the establishment of the patient’s baseline assessment in the clinical setting
or at home, carrying out preoperative interview and preparing the patient for the anesthetic to be given and the surgery. Nurses have to
assess and fulfill the physical, psychological, spiritual, social, needs. Nurses has a responsibility to take informed consent, patient
education , part preparation, bowel preparation ,assess for any special needs, nutritional status, pre-op medication and vital , pre-op
general healthy and tell patient how to cope with surgery postoperatively like post-op exercise, breathing exercise, special diet, family
support and early ambulation with good ROM.

ASSIGNMENT :

Q- Write down the “NURSES RESPONSIBILITIES IN PREOPERATIVE PHASE”?

EVALUATION:

Q1:- Which of the following is not a phase of peri-operative nursing?

a) Pre-operative b) Post-operative c) Intra-operative d) peri-operative

Q2:- What is the goal of the preoperative phase?

a) To assess patient need during surgery b) to assess patient need after surgery c) To assess need of patient who is
undergoing a surgery d) all of above

Q3:- Importance of pre-operative phase is?

a) To assess patient recovery b) to rule out special need c) to evaluate pre surgery status d) all of above

Q4:- What of the following drug discontinue prior to surgery?

a) Prednisolone b) Warfarin c) Propanolol d) Aspirin

Q5: Informed consent is?

a) Taken prior to Surgery b) Taken after telling patient all aspects of surgery c) taken from guardian for one who is under18
d) All of above
REFERENCES:

BOOK :-

 Joecy M. Black, “Medical-Surgical Nursing”, edition 6, published by Saunders, page no. 184-199
 Lewis’s “ Medical Surgical Nursing, Assessment and Management of Clinical Problem” , 2nd south Asia edition, volume- I,
Elsevier Publication, pg. no.- 233-245
 Linda , “Priorities in Crirtical Care Nursing”, Fourth Edition, Mosby Publication,
 Phipp’s “Medical Surgical Nursing, Health and Illness Prespectives, 8th Edition, Mosby Publication, Pg.no.- 237-260
 Suddarth’s and brunner, “ Textbook of medical –surgical nursing”, 11th Edition, Wolters kluwer Publication, pg no.-198-205

ONLINE:-

 http://nurseslabs.com/preoperative-phase/
 https://en.wikipedia.org/wiki/Perioperative
 http://www.brooksidepress.org/Products/Nursing_Care_of_the_Surgical_Patient/lesson_1_Section_1.htm
 http://www.dictionary.com/browse/preoperative

ARTICLE :-

 http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html
 http://www.surgeryencyclopedia.com/Pa-St/Preoperative-Care.html#ixzz4JMAOPtMU