DIRECTORATE OF NURSING AFFAIRS

GENERAL NURSING PROCEDURES

PRE OPERATIVE CARE

DEFINITION Pre-operative care is the physical, psychological, emotional, and spiritual preparation and support of the patient prior to surgery.

PURPOSE To prepare the patient for surgery incorporating the following: 1. Physical support a. To teach the patient relevant exercises, e.g. deep breathing, leg exercises, and support of the wound exercises, to reduce or prevent postoperative complications. b. To provide the patient with appropriate information in relation to the proposed operative procedure. c. To ensure that the patient is in optimal physical condition prior to surgery as related to the pre-operative checklist, and to reduce possible cross infection factors. Psychological and Emotional support a. To assist the patient to understand and accept the purpose of surgery. b. To assess and assist in the management of patients anxiety. Spiritual support a. To assist in meeting the spiritual needs of the patient. To administer pre-operative medication

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3.

4.

EQUIPMENT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Theatre gown Theatre disposable cap Preoperative checklist Hypo-allergenic tape Denture container, if required Valuables book to record patients valuables kept in hospital custody during surgical intervention Sphygmomanometer, stethoscope, and thermometer Observation record chart Patient case notes with signed consent Identification bracelet as required.

SECTION 25 PRE-OPERATIVE CARE

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DIRECTORATE OF NURSING AFFAIRS

GENERAL NURSING PROCEDURES

PROCEDURE
SN Action Rationale

1.

Check the physicians order and care plan for specific instructions. Identify the patient.. Ensure that the patient is wearing an identification bracelet with the correct information. Check identification of hospital number and full name against the patients case notes. Ensure that the physician has explained the procedure to the patient and his family. Allow time for questions. Ascertain whether preoperative education has been fully understood by the patient and relatives; if appropriate by prompting discussions.

To ensure correct information.

To fulfil legal requirement and hospital policy. To perform the right procedure on the right patient.

2.

To relieve patient anxiety and reassure his family.

3.

To determine whether the patient understands the reasons for surgery and how to minimize postoperative discomfort and to reduce possible complications associated with the surgery. To fulfil legal requirement and hospital policy.

4.

Ensure that the consent form has been signed, witnessed and countersigned (By patient, relatives, and physician). Draw curtains to ensure privacy and quietness within the immediate bed environment. Monitor and record baseline observations.

5.

To avoid unnecessary embarrassment to the patient during the procedure. To ensure comfort and dignity. To establish a preoperative baseline and report any abnormal findings.

6.

Check that the patient has undergone all To ensure that all relevant laboratory required preoperative examinations e.g. and X-ray information is available for X-ray, group and cross-matching of the surgical team prior surgery. blood, and that the results are entered and attached in the patients notes. Ensure that the patient has undergone To minimize the risk of infection. the correct and appropriate skin To identify allergic/sensitivity reactions preparation as per the physicians order. to skin preparation solution. To prepare operative site for ready surgical access. Assist the patient to change into the hospital theatre gown and cap. To minimize the risk of infection.

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9.

SECTION 25 PRE-OPERATIVE CARE

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DIRECTORATE OF NURSING AFFAIRS

GENERAL NURSING PROCEDURES

SN

Action

Rationale

10.

Ensure that the patient has observed the following: a. Preoperative fasting for prescribed length of time. b. Urine has been passed prior to premedication.

c. Bowels have been well opened

d. Prostheses, if any have been removed or noted, in patients case notes and on pre-operative checklist. Dental crowns or bridges should be removed until the patient fully recover after surgery and hearing aids should be left in position e. Jewellery and cosmetics removed. Note Jewellery is to be recorded in the valuables book. 11. Administer premedication as per physicians order and hospital drug policy and IV.Fluid should be started with correct cannula size. Advice the patient to remain in bed after the administration of premedication. Place bed rails in position and call bell within easy reach. Document the procedure appropriately.

To prevent inhalation of regurgitated food while under anaesthesia. To prevent urinary incontinence due to muscle relaxation. To decrease the danger of inadvertent injury to the bladder. To ensure an empty bowel before surgery to prevent danger of faecal spillage. To prevent trauma to the patient and damage or loss of prostheses. Hearing aids to facilitate communication.

Metal jewellery or hairpins may be lost accidentally, and may cause damage to the patient through burns and abrasions and ready source for cross infection.

To allay fears and anxiety. Cannula may be needed for blood transfusion during the surgery

12.

To avoid danger of falls.

13.

To fulfil legal requirement and ensure continuity of care. To enable the surgical team to have full access to the patients history and investigations and to ensure that the assigned nurse has verified that the prescription has been completed. To prevent injury to the neck, etc. during transfer from the ward to the operating theatre.

14.

Ensure that any relevant information, e.g. case notes with signed preoperative checklist and X-ray films accompany the patient to theatre.

15.

Ensure the patient is supported fully on the canvas, especially the head when transferred from the ward bed to the trolley.

SECTION 25 PRE-OPERATIVE CARE

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