- => Subjective Data
- -> Patient interview by preop nurse: May be performed over phone before admission, or to pt on flood, care nurse
- -detailed; Includes physical, emotional, cultural, and spiritual well-being or needs of the patient based on this surgery
- -History of previous surgery: when, how long it happened?
- ->Complications with surgery or adverse reaction to anesthesia: any rnxs to anest? post op healing probs? Post op pain? Intra op problems (diff going to sleep, waking up during surgery).
- Ask questions of surgical history
-Family history of complications with anesthesia; condition where pts can have allergic rnx to anesthesitia of hypermetabolic state-> increasing temp, "Malignant Hyperthermia".
Things that we should be doing as nurses. As body increases in temp, everything goes tight. "Tetany" Heart can't beat, no blood flow, we can't actually resusitate that pt until giving meds to stop that procedure. Pt can't test positive for this in blood if a family member in past that has had this reaction. It's like an internal allergy. In relationship to inhaled anesthesia. Anecdote: Dantreium.
- -Knowledge of proposed surgery and proposed anesthesia (informed consent): ask if they understand procedure and explain in their own words what type of procedure they're going into. Know the risks and benefits. We as nurses must assess to see how much education they have on procedure and if they aren't well informed then we need to send them back to surgeon b/c that pt can't be taken into surgery.-Recent illness? Flu, UTI, skin infection, how recent? Anything that hasn't been cured in the last week. Must have good health.
- -Past and current medical problemsChronic illnessesRecent cardiac or respiratory problems: if so, what? Are they resolved? what have they done to manage them?
- Neurological deficits
- Urinary or kidney disease* important b/c anest meds given are metabolized through these target end organs
- Liver disease
- Mobility difficulty: Ex: using walker before that ankle surgery.. or shoulNutritional status: Diet high in protein postoperative, Dietary habits. ; Have they had recent weight "change" in past month? Current nutritioinal status? Any specifc dietary needs? DO you get enough protein and iron if you're vegan that will be lost during surgery.
=> MedicationsCurrent useHerbal -see syllabus; states change of homeostatis. Over the counter (OTC)PRN's- certain ones could delay healing or prlong bleeding timeRecreational drug use: "how much do you use?" for LOC, Anesth needs to know the most b/c if it's with system, then it fights for those receptor sites so they need MUCH MORE anesth. meds to put them to sleep. Tell them to please not to use drugs within 24 hours because those drugs compete with the drugs we are going to give you to put you to sleep.
=> Allergies drugs food adhesive material (tape, band aid): because of dressings latex, etc.: gloves, and it's everywhere in that OR. Latex is airborne "spores in air". All tubings, things for the anesth. meds. have latex. They will be put in a non-latex room, with latex free equipment. usually one of the first procedures.Smoking, alcohol, and recreational drug (substance) use.
Smoking & Nicotine.. CO2
from Bicarb nicotine has strong affinity to hemoglobins so Oxygen has difficulty attaching to hemoglobin. More competitiion. Again, we ask pt to not smoke for 24 hours AT LEAST before surgery
competes with anest and pain medications, messes with homeostatis of glucose levels. Difficult to utilize. Tell them not to drink for 24 hours. Ask them about alchol use.. make sure it's specific.