UNIVERSITY OF THE VISAYAS COLLEGE OF NURSING BANILAD, MANDAUE CITY -PRE-OPERATIVE PHASEPreparing the Client on the Day of the

Surgery

SUBMMITTED TO: MRS. JOY M. CHIONG, RN. CLINICAL INSTRUCTOR SUBMMITTED BY: AGBAY, GERLY AVENIDO, ROGELIO BELEN, JOSEPHUS JOHN CANLOM, MARK JASON DEDICATORIA, LOUELLA DUTERTE, MARK JOEY GABUCAN, FLORA MAE PARDILLO, RICO RODIS, LYLE TOBIAS, JOHN CHRISTOPHER EARLY MORNING CARE (PATIENT PREPARATION) 1. The patient changes into a hospital gown that is left untied and open in the back. 2. Ensure adequate intravenous access.

3. The patient with long hair may braid it, remove hairpins, and cover the head completely with a disposable paper cap. 4. Client must be wearing an Identification Band.

5. The mouth is inspected, and dentures or plates are removed. If left in the mouth, these items could easily fall to the back of the throat during induction of anesthesia and may cause respiratory obstruction. 6. Jewelry is not worn to the operating room to prevent injury.

7. Valuables of the client should be with a family member or locked up in hospital safe.

8. All patients (except those with urologic disorders) should void immediately before going to the OR to promote continence during low abdominal surgery and to make abdominal organs more accessible.

PRE-OPERATIVE MEDICATION

Most scheduled medications that a person receives while in the hospital or takes at home every day will be continued up until the time of surgery. Most oral medications should be given with just enough water to swallow them, even when a client is going to have surgery first thing in the morning.

Cardiovascular medications such as antihypertensives and heart medications are especially important for the client to receive.

Exception to the practice of continuing scheduled medications prior to surgery include administration of drugs such as insulin and oral antihyperglycemics, nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, and anticoagulants like heparin or coumadin. Because food is being withheld, giving insulin or oral antihyperglycemic drugs is likely to result in a dangerously low blood sugar level. The way insulin and glucose administration is handled will depend on the severity of the clients disease and the preference of the physician and anesthesia provider. Anticoagulants and NSAIDs affect clotting. With some types of surgery, the bleeding cause by aspirin-like drugs or low dose heparin is more likely. In some cases, no NSAIDs are allowed for 10 days to 2 weeks prior to surgery. In other circumstances, they may be taken right up until surgery.

PRE-ANESTHETIC CARE

Complete preoperative checklist. Make sure all preoperative orders are executed, especially those for blood tests, preoperative medications, and blood from the blood bank. Check, verify, and document the presence or absence of drug allergies for each client.

Administer regular daily oral medications with a small sip of water as ordered.

Remind the client of the importance of following instructions regarding any eating or drinking restrictions.

Administer preoperative medications as close to the ordered time as possible. Timing can be crucial to achieving the desired effect at the correct time.

If the client responds abnormally to the preoperative medication, notify the anesthesia department immediately.

Be sure the clients chart is complete when it goes to the operating room with the client. Recent diagnostic test results are especially important to include; otherwise, surgery may be delayed while these results are sought.

Make sure the clients consents are in order and included in the chart when the client is transported to surgery.

ADMINISTERING PRE-ANESTHETIC MEDICATION

The use of pre-anesthetic medication is minimal with ambulatory or outpatient surgery. If pre-anesthetic medication is administered, the patient is kept in bed with the side rails raised because the medication can cause lightheadedness or drowsiness; during this time, the nurse observes the patient for any untoward reaction to the medication; the immediate surroundings are kept quiet to promote relaxation.

EXAMPLES OF PRE-ANESTHETIC MEDICATIONS: A. Promethazine Hydrochloride includes the following brands (among others): Histantil Pentazine Phenazine Phencen Phenergan Phenoject-50 Prometh Prorex Prothazine V-Gan

used for pre-operative, post-operative, and obstetric sedation as adjunct to analgesics for control of pain.

B. Ranitidine is an H2-receptor antagonist include the following brands (among others): Drugmakers Biotech Ramadine Pharex Zantac it blocks daytime and nocturnal basal gastric aced secretion stimulated by histamine and reduces gastric acid release in response to food, pentagastrin, and insulin; shown to inhibit 50% of stimulated gastric acid secretions.